Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials

Background: Moderate-to-severe coronary calcification is associated with worse outcomes following percutaneous coronary intervention (PCI). We aimed to assess the safety and efficacy of optical coherence tomography (OCT) compared with conventional angiography in PCI guidance of moderate-to-severe calcified coronary artery lesions. Methods: Multiple databases were systematically searched for outcomes of OCT- versus angiography-guided PCI in calcified lesions. Study selection and data extraction were conducted in accordance with the PRISMA guidelines. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven target vessel revascularization (ID-TVR). Secondary endpoints included clinical (i.e., TVF components, stent thrombosis, and 30-day major adverse cardiovascular events [MACEs]), imaging, and procedural outcomes. Results: Four randomized controlled trials involving 3186 participants were included. Compared with angiography, OCT was associated with a significant reduction in TVF (risk ratio [RR] = 0.66; 95% confidence interval [CI]: 0.52–0.82), cardiac death (RR = 0.39; 95% CI: 0.22–0.70), TV-MI (RR = 0.63; 95% CI: 0.42–0.94), and stent thrombosis (RR = 0.24; 95% CI: 0.08–0.72). However, there were no significant changes in ID-TVR (RR = 0.77; 95% CI: 0.55–1.08) or 30-day MACEs (RR = 0.50; 95% CI: 0.16–1.61). Most procedural outcomes varied across studies and showed significant heterogeneity. Conclusions: OCT-guided PCI was associated with better clinical outcomes compared with angiography-guided PCI in this patient population. However, larger randomized trials are needed to confirm these results.