Luo Jiayi, Xue Yu, Xu Zimin, Xu Kai, Li Yang, Han Yaling
Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
Quant Imaging Med Surg. 2025 Mar 3;15(3):2246-2257. doi: 10.21037/qims-24-1628. Epub 2025 Feb 26.
The superiority of optical coherence tomography (OCT) guidance over coronary angiography (CA) guidance in optimizing therapy in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. Consequently, we conducted a comprehensive meta-analysis with the objective of providing a higher level of evidence.
The databases of PubMed/Medline, Embase, and Cochrane Central were searched in March 2024. The outcomes of this meta-analysis included all-cause death, cardiovascular death, major adverse cardiovascular events (MACE), restenosis, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), post-intervention minimum stent area (MSA), post-intervention minimum lumen diameter (MLD), and follow-up MLD. Statistical analysis was conducted using RevMan 5.3 and STATA version 18. The degree of heterogeneity was evaluated using the I statistical test. When I exceeded 50%, heterogeneity was deemed to be substantial, prompting the application of a random effects model; conversely, a fixed effects model was employed. The results were expressed as risk ratio (RR) and mean deviation (MD) with their corresponding 95% confidence interval (CI).
A total of 25 articles were included in the study. In terms of clinical outcomes, OCT-guided PCI was associated with a significant reduction in all-cause death (RR =0.62; 95% CI: 0.47-0.83; P=0.001), cardiovascular death (RR =0.47; 95% CI: 0.32-0.69; P<0.0001), and MACE (RR =0.65; 95% CI: 0.54-0.77; P<0.00001). Meanwhile, no statistically significant differences were observed for restenosis (RR =0.91; 95% CI: 0.73-1.13; P=0.38), MI (RR =0.83; 95% CI: 0.69-1.00; P=0.05), TLR (RR =0.86; 95% CI: 0.66-1.10; P=0.23), and TVR (RR =0.82; 95% CI: 0.63-1.07; P=0.15). In terms of surrogate endpoints, OCT-guided PCI was associated with a significant enhancement of MSA (MD =0.30; 95% CI: 0.04-0.56; P=0.03) and MLD at follow-up (MD =0.12; 95% CI: 0.02-0.22; P=0.02). Nevertheless, no significant increase in the post-intervention MLD was observed (MD =0.04; 95% CI: -0.02 to 0.10; P=0.19).
Compared with CA, the use of OCT for PCI guidance may be an effective strategy to optimize treatment.
在接受经皮冠状动脉介入治疗（PCI）的患者中，光学相干断层扫描（OCT）引导在优化治疗方面是否优于冠状动脉造影（CA）引导仍不确定。因此，我们进行了一项全面的荟萃分析，目的是提供更高水平的证据。
2024年3月检索了PubMed/Medline、Embase和Cochrane Central数据库。该荟萃分析的结果包括全因死亡、心血管死亡、主要不良心血管事件（MACE）、再狭窄、心肌梗死（MI）、靶病变血运重建（TLR）、靶血管血运重建（TVR）、干预后最小支架面积（MSA）、干预后最小管腔直径（MLD）和随访MLD。使用RevMan 5.3和STATA 18版进行统计分析。使用I统计检验评估异质性程度。当I超过50%时，认为异质性很大，促使应用随机效应模型；相反，则采用固定效应模型。结果以风险比（RR）和平均偏差（MD）及其相应的95%置信区间（CI）表示。
该研究共纳入25篇文章。在临床结局方面，OCT引导的PCI与全因死亡（RR =0.62；95%CI：0.47 - 0.83；P =0.001）、心血管死亡（RR =0.47；95%CI：0.32 - 0.69；P <0.0001）和MACE（RR =0.65；95%CI：0.54 - 0.77；P <0.00001）的显著降低相关。同时，再狭窄（RR =0.91；95%CI：0.73 - 1.13；P =0.38）、MI（RR =0.83；95%CI：0.69 - 1.00；P =0.05）、TLR（RR =0.86；95%CI：0.66 - 1.10；P =0.23）和TVR（RR =0.82；95%CI：0.63 - 1.07；P =0.15）未观察到统计学显著差异。在替代终点方面，OCT引导的PCI与MSA的显著增加（MD =0.30；95%CI：0.04 - 0.56；P =0.03）和随访时的MLD增加（MD =0.12；95%CI：0.02 - 0.22；P =0.02）相关。然而，干预后的MLD未观察到显著增加（MD =0.04；95%CI： - 0.02至0.10；P =0.19）。
与CA相比，使用OCT进行PCI引导可能是优化治疗的有效策略。
