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Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis.

by Kuku, Kayode; Ekanem, Emmanuel; Azizi, Viana; Melaku, Gebremedhin; Bui, Anh B; Meirovich, Yael F; Dheendsa, Aaphtaab; Beyene, Solomon; Hideo-Kajita, Alexandre; Lipinski, Michael J; Waksman, Ron; Garcia-Garcia, Hector M.
Citation: The International Journal of Cardiovascular Imaging. 34(4):503-513, 2018 Apr..Journal: The international journal of cardiovascular imaging.Published: ; 2018ISSN: 1569-5794.Full author list: Kuku KO; Ekanem E; Azizi V; Melaku G; Bui A; Meirovich YF; Dheendsa A; Beyene S; Hideo-Kajita A; Lipinski MJ; Waksman R; Garcia-Garcia HM.UI/PMID: 29151138.Subject(s): Chi-Square Distribution | Coronary Angiography | Coronary Artery Disease/dg [Diagnostic Imaging] | Coronary Artery Disease/mo [Mortality] | *Coronary Artery Disease/th [Therapy] | Coronary Thrombosis/dg [Diagnostic Imaging] | Coronary Thrombosis/et [Etiology] | *Coronary Vessels/dg [Diagnostic Imaging] | Humans | Myocardial Infarction/dg [Diagnostic Imaging] | Myocardial Infarction/et [Etiology] | Odds Ratio | Percutaneous Coronary Intervention/ae [Adverse Effects] | *Percutaneous Coronary Intervention/mt [Methods] | Percutaneous Coronary Intervention/mo [Mortality] | Predictive Value of Tests | Radiography, Interventional | Risk Factors | Time Factors | *Tomography, Optical Coherence | Treatment Outcome | Ultrasonography, InterventionalInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1007/s10554-017-1272-2 (Click here) Abbreviated citation: Int J Cardiovasc Imaging. 34(4):503-513, 2018 Apr.Abstract: The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n=1753) and OCT-guidance versus IVUS-guidance (n=1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p=0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p=0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p=0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p=0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p=0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p=0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p=0.47), MI (OR 0.56 [0.12, 2.70] p=0.47), ST (OR 0.43 [0.06, 2.95] p=0.39), and TLR(OR 0.99 [0.45, 2.18] p=0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.

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