Angiography vs OCT vs IVUS guidance for PCI: a network meta-analysis

A network meta-analysis including 20 randomised-controlled trials and data from 12,428 patients showed that intravascular imaging (IVI)-guided PCI outperformed angiography-guided PCI in terms of reducing target-lesion failures, all-cause mortality, and stent thrombosis. No differences were observed for optical coherence tomography (OCT)-guided compared with intravascular ultrasound (IVUS)-guided PCI and each individually against angiography.

Prof. Gregg Stone (Icahn School of Medicine at Mount Sinai, NY, USA) and co-investigators conducted a ‘real-time’ network meta-analysis evaluating the effects of IVI-guided versus angiography-guided PCI and OCT-guided versus IVUS-guided PCI [1]. The primary endpoint was target-lesion failure, defined as cardiac death, target vessel-related myocardial infarction (TVMI), or ischaemia-driven/clinically-driven target-lesion revascularisation (TLR). The authors included 20 randomised trials, with publication years between 2010 and 2023, totalling 12,428 patients.

Included were 18 trials (11,502 patients) that compared IVI guidance with angiography guidance. The primary endpoint was met for this comparison, favouring IVI guidance (RR 0.69; 95% CI 0.61–0.78; P<0.0001). All 3 components of the primary endpoint significantly favoured IVI guidance over angiography guidance: cardiac death (RR 0.54; 95% CI 0.40–0.74; P<0.0001); TVMI (RR 0.80; 95% CI 0.66–0.97; P=0.02); TLR (RR 0.71; 95% CI 0.59–0.85; P=0.0001). Dr Stone added that IVI-guidance also significantly reduced all-cause death (RR 0.75; 95% CI 0.60–0.93; P=0.009) and stent thrombosis (RR 0.48; 95% CI 0.31–0.76; P=0.002) compared with angiography guidance. OCT-guided PCI was compared with IVUS-guided PCI in 4 trials (1,316 patients). No significant differences were reported between these 2 techniques (see Table).

Table: Network evidence, OCT-guided PCI versus IVUS-guided PCI [1]



MI, myocardial infarction; TLF, target-lesion failure; TLR, target-lesion revascularisation; TVMI, target vessel-related MI; TVR, target-vessel revascularisation.

“Future research is needed to determine which lesion types benefit most from IVI guidance, and whether there are subtle differences in outcomes between OCT- and IVUS-guidance of PCI procedures,” Prof. Stone concluded.

1. 
   
   1. Stone G, et al. Intravascular imaging guidance for PCI: a real-time updated network meta-analysis. Hot Line Session 4, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.

Copyright ©2023 Medicom Medical Publishers



Posted on 30 October 202323 April 2024