BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
