Dynamic coronary roadmap-guided versus traditional percutaneous coronary intervention techniques in contrast medium volume reduction: a systematic review and meta-analysis

Abstract Background Dynamic Coronary Roadmap (DCR) is a novel software providing a motion-compensated, real-time overlay of coronary arteries to assist PCI device navigation with a single contrast injection. This meta-analysis evaluated the effectiveness and safety of DCR. Methods We searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase from inception to May 5, 2024. Outcomes were pooled as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) using random-effects models. PROSPERO registration: CRD42024553689. Results Eight studies (two RCTs, six observational; 1,512 patients) were included. DCR-guided PCI significantly reduced contrast media volume (MD = − 45.82 mL, 95% CI − 68.33 to − 23.30; P < 0.001; I 2 = 97%), air kerma (MD = − 283.09 mGy, 95% CI − 474.47 to − 91.70; P = 0.004; I 2 = 99%), dose area product (MD = − 6.85 Gy/cm 2 , 95% CI − 10.48 to − 3.22; P = 0.0002; I 2 = 82%), radiation duration (MD = − 2.79 min, 95% CI − 4.59 to − 0.98; P = 0.002; I 2 = 94%), and procedural duration (MD = − 3.51 min, 95% CI − 6.69 to − 0.32; P = 0.03; I 2 = 0%). No significant differences were found in procedural success (RR = 1.00; 95% CI 0.99–1.01; I 2 = 0%) or acute kidney injury incidence (RR = 0.40; 95% CI 0.15–1.08; I 2 = 0%). Risk of bias was mixed for RCTs (low to high risk across domains) and moderate to high for observational studies, with most scoring ≥ 7 on the Newcastle–Ottawa Scale. Conclusion DCR-guided PCI was associated with reductions in contrast use and radiation metrics without compromising procedural success; however, the overall certainty of evidence is low due to study design limitations, risk of bias, and substantial heterogeneity, warranting cautious interpretation.