Shuja Muhammad Hamza, Ahmed Muhammad, Hannat Ramish, Khurram Laiba, Hasnain Sheikh Hamza Ali, Shuja Syed Hasan, Raja Adarsh, Ahmed Jawad, Soni Kriti, Wani Shariq Ahmad, Goyal Aman, Pushparaji Bala, Hasan Ali, Ahmed Raheel, Jain Hritvik
Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan.
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Pakistan.
Diagnostics (Basel). 2025 Jul 30;15(15):1907. doi: 10.3390/diagnostics15151907.
: Despite advances in coronary artery disease (CAD) treatment, challenges persist, particularly in complex lesions. While percutaneous coronary intervention (PCI) is widely used, its outcomes can be affected by complications like restenosis. Optical coherence tomography (OCT), offering higher-resolution imaging than angiography, shows promise in guiding PCI. However, meta-analytical comparisons between OCT-guided and angiography-guided PCI remain limited. : Databases, including PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov, were queried through May 2025 to identify randomized controlled trials (RCTs) comparing OCT-guided PCI with angiography-guided PCI. Data were pooled using risk ratios (RRs) and mean difference (MD) with 95% confidence intervals (CIs) in a random-effects model. : Five RCTs involving 5737 patients (OCT: 2738 and angiography: 2999) were included. On pooled analysis, OCT-guided PCI was associated with a notable reduction in major adverse cardiovascular event (MACE) (RR: 0.71, = 0.0001), cardiac mortality (RR: 0.43, = 0.003), target lesion revascularization (TLR) (RR: 0.53, = 0.007), and stroke (RR: 0.17, = 0.02), compared to angiography-guided PCI. No significant differences were noted for all-cause mortality and myocardial infarction. : In patients with complex coronary lesions, OCT-guided PCI reduces the risk of MACE, cardiac mortality, TLR, and stroke, compared to angiography-guided PCI only. This study supports incorporating advanced imaging techniques like OCT to improve clinical outcomes, especially in complex PCIs.
尽管冠状动脉疾病（CAD）治疗取得了进展，但挑战依然存在，尤其是在复杂病变中。虽然经皮冠状动脉介入治疗（PCI）被广泛应用，但其结果可能会受到再狭窄等并发症的影响。光学相干断层扫描（OCT）提供了比血管造影更高分辨率的成像，在指导PCI方面显示出前景。然而，OCT引导与血管造影引导PCI之间的荟萃分析比较仍然有限。通过查询包括PubMed、Scopus、Cochrane图书馆和ClinicalTrials.gov在内的数据库，截至2025年5月，以识别比较OCT引导PCI与血管造影引导PCI的随机对照试验（RCT）。在随机效应模型中，使用风险比（RRs）和平均差（MD）以及95%置信区间（CIs）汇总数据。纳入了五项涉及5737名患者的RCT（OCT组：2738名，血管造影组：2999名）。汇总分析显示，与血管造影引导PCI相比，OCT引导PCI与主要不良心血管事件（MACE）显著降低相关（RR：0.71， = 0.0001）、心脏死亡率（RR：0.43， = 0.003）、靶病变血运重建（TLR）（RR：0.53， = 0.007）和中风（RR：0.17， = 0.02）。全因死亡率和心肌梗死未发现显著差异。在患有复杂冠状动脉病变的患者中，与仅血管造影引导PCI相比，OCT引导PCI降低了MACE、心脏死亡率、TLR和中风的风险。本研究支持采用OCT等先进成像技术来改善临床结果，尤其是在复杂PCI中。
