Optical coherence tomography-guided percutaneous coronary intervention compared to angiography-guided percutaneous coronary intervention for complex lesions

doi:10.4330/wjc.v17.i9.110403

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World Journal of Cardiology

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World J Cardiol. Sep 26, 2025; 17(9): 110403
Published online Sep 26, 2025. doi: 10.4330/wjc.v17.i9.110403

Optical coherence tomography-guided percutaneous coronary intervention compared to angiography-guided percutaneous coronary intervention for complex lesions

Muhammad Burhan, Humza Saeed, Muhammad Usama, Aamnah Tariq, Saira Shafiq, Sonia Hurjkaliani, Minahil Iqbal, Sufyan Shahid, Salman Khalid, Naeem Khan Tahirkheli

Muhammad Burhan, Humza Saeed, Muhammad Usama, Aamnah Tariq, Saira Shafiq, Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi 87500, Punjab, Pakistan

Sonia Hurjkaliani, Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan

Minahil Iqbal, Department of Internal Medicine, Allama Iqbal Medical College, Lahore 54000, Punjab, Pakistan

Sufyan Shahid, Department of Internal Medicine, Khawaja Muhammad Safdar Medical College, Sialkot City 51300, Punjab, Pakistan

Salman Khalid, Naeem Khan Tahirkheli, Department of Cardiology, Oklahoma Heart Hospital, Oklahoma City, OK 73120, United States

Author contributions: Burhan M designed research, performed research, analyzed data, and wrote the paper; Saeed H performed research, analyzed data, and wrote the paper; Usama M performed research and analyzed data; Tariq A performed research and analyzed data; Shafiq S, Hurjkaliani S, Iqbal M, and Shahid S wrote the paper; Khalid S supervised research, validated findings, and wrote the paper; Tahirkheli N supervised research, validated findings, conceptualized the study, and wrote the paper; all of the authors read and approved the final version of the manuscript to be published.

Conflict-of-interest statement: The authors have no conflicts of interest statement to declare.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Humza Saeed, Researcher, Department of Internal Medicine, Rawalpindi Medical University, New Teaching Block, Rawalpindi 87500, Punjab, Pakistan. hamzasaeed309@gmail.com

Received: June 7, 2025
Revised: June 12, 2025
Accepted: August 25, 2025
Published online: September 26, 2025
Processing time: 103 Days and 22.5 Hours

Abstract

BACKGROUND

Optical coherence tomography (OCT) offers detailed cross-sectional imaging during percutaneous coronary intervention (PCI), aiding in anatomically complex coronary lesions. Despite its advantages, evidence on the clinical effectiveness of OCT-guided PCI remains limited.

AIM

To compare clinical outcomes of OCT-guided vs angiography-guided PCI in patients with complex lesions.

METHODS

Major databases were systematically searched for randomized controlled trials (RCTs) comparing OCT-guided and angiography-guided PCI in complex lesions. Primary outcomes included major adverse cardiovascular events (MACE) and target vessel failure (TVF); secondary outcomes included mortality, myocardial infarction (MI), and other procedural outcomes. A random-effects model was used to pool risk ratio (RR), with 95%CI. Statistical analysis was conducted in R software (v4.4.1), with significance set at P < 0.05.

RESULTS

Five RCTs (5737 patients) showed OCT-guided PCI significantly reduced MACE (RR: 0.63, 95%CI: 0.52-0.77, P < 0.01), TVF (RR: 0.68, 95%CI: 0.56-0.83, P < 0.01), all-cause (RR: 0.58, 95%CI: 0.38-0.87, P < 0.01) and cardiac mortality (RR: 0.43, 95%CI: 0.24-0.76, P < 0.01), target-lesion revascularization (RR: 0.53, 95%CI: 0.33-0.84, P < 0.01), stent thrombosis (RR: 0.52, 95%CI: 0.31-0.86, P = 0.01), and target-vessel MI (RR: 0.64, 95%CI: 0.42-0.97, P = 0.04) vs angiography-guided PCI. Periprocedural MI, any revascularization, target-vessel revascularization, and contrast-associated kidney injury were similar between groups.

CONCLUSION

OCT-guided PCI improves outcomes in complex lesions by reducing MACE, TVF, mortality, stent thrombosis, and target-vessel MI. These findings highlight the need for further large-scale RCTs to confirm its benefits.

Keywords: Optical coherence tomography; Angiography; Percutaneous coronary intervention; Complex lesion; Major adverse cardiovascular event; Meta-analysis; Intravascular imaging

Core Tip: This meta-analysis of five randomized controlled trials (RCTs) evaluates the clinical benefits of optical coherence tomography (OCT)-guided vs angiography-guided percutaneous coronary intervention (PCI) in patients with complex coronary lesions. OCT-guided PCI was associated with significantly reduced rates of major adverse cardiovascular events, target vessel failure, mortality, and stent thrombosis. These findings support OCT guidance as a superior imaging modality during PCI in complex cases and underscore the need for further large-scale RCTs to validate its routine use in clinical practice.