The prognosis of Optical Coherence Tomography-Guided versus Intravascular Ultrasound-Guided Implantation of Drug-Eluting Stents: A Meta-Analysis from Randomized controlled trials

Abstract Objective Some observational studies and a few meta-analyses have shown a similarity of optical coherence tomography (OCT) in guiding drug-eluting stent (DES) implantation compared with intravascular ultrasound (IVUS). However, a comparison of long-term outcomes between guidance OCT or IVUS from randomized controlled trials (RCTs) is lacking. This study aimed to compare the prognosis of IVUS vs. OCT in guiding stent implantation. Methods Randomized controlled trials (RCTs) related to compare long outcomes of IVUS versus OCT in guiding stent implantation from inception to 15 October 2023 were identified using PubMed, Cochrane Library, Medline, Web of Science and EMBASE databases. Two researchers independently screened articles, extracted data, and assessed the quality of each study according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR). The primary clinical prognosis including major adverse cardiac events (MACEs), all-cause mortality, all-cause myocardial infarction, all revascularization, and stent thrombosis. Results Five RCTs (3,339 patients) were included (OCT guidance = 1,680; IVUS guidance = 1,659). There were similar results for all long-term outcomes between OCT and IVUS-guided DES implantation: major adverse cardiac events (relative risk (RR) = 0.96; 95% confidence interval (CI), 0.68–1.36; P = 0.82), all-cause mortality (RR = 1.00; 95% CI, 0.52–1.91; P = 1.00), all-cause myocardial infarction (RR = 0.81; 95% CI, 0.44–1.49; P = 0.50), all revascularization (RR = 1.02; 95% CI, 0.74–1.42; P = 0.88), and stent thrombosis (RR = 0.44; 95% CI, 0.10–1.97; P = 0.28). Conclusions This meta-analysis suggested no significant difference in prognosis between OCT-guided vs . IVUS-guided coronary stent implantation.