Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies
15 affiliations
- 1Winchester Cardiology and Vascular Medicine, Winchester Medical Center, 1880 Amherst Street, Winchester, VA 22601, USA.
- 2Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, David Weatherall Building, Keele University, Staffordshire ST5 5BG, UK.
- 3DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA.
- 4Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
- 5Inova Schar Heart and Vascular, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA.
- 6King Salman Heart Center, King Fahad Medical City, P.O. Box 13534, Riyadh 11525, Saudi Arabia.
- 7Department of Internal Medicine, Mercy St. Vincent Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA.
- 8Department of Cardiology, Tulane University Hospital, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
- 9East Jefferson Hospital, 4200 Houma Boulevard, Metairie, LA 70006, USA.
- 10Padra Clinic, 12 Blvrd, Anas Ibn Malik Street, Al Malqa District, Riyadh, Saudi Arabia.
- 11Brown University Health Cardiovascular Institute, 2 Dudley Street, Suite 360, Providence, RI 02905, USA.
- 12Division of Cardiology, UCSF Fresno, University of California San Francisco, 155 North Fresno Street, Fresno, CA 93701, USA.
- 13Heart Health Center, King Saud Medical City, Riyadh First Health Cluster, Sheikh Abdulaziz Bin Abdulrahman Al Saud Street, Al Shumaisi District, P.O. Box 780, Riyadh 12746, Saudi Arabia.
- 14Heart, Vascular, and Thoracic Institute, Cleveland Clinic Abu Dhabi, 59 Hamouda Bin Ali Al Dhaheri Street, Al Maryah Island, Abu Dhabi, United Arab Emirates.
- 15Cardiac Center, King Fahd Armed Forces Hospital, Al Kurnaysh Road, Jeddah 23311, Saudi Arabia.
Abstract
Aims
Uncertainty persists regarding the comparative efficacy of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) vs. angiography-guided percutaneous coronary intervention (PCI). We synthesized randomized evidence using reconstructed individual participant data (IPD) and compared the two modalities indirectly.Methods and results
MEDLINE and CENTRAL were searched up to 31 March 2026. IPD were reconstructed from published Kaplan-Meier curves. Primary analyses used one-stage stratified Cox models; secondary analyses included random-effects and Bayesian hierarchical models. The primary outcome was major adverse cardiovascular events (MACE). Twenty-three randomized controlled trials enrolling 21 176 patients were included (16 IVUS, N = 15 209; 7 OCT, N = 5967). IVUS-guided PCI reduced MACE [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.67-0.83; P < 0.001], target-vessel revascularization (TVR; HR 0.70; 0.60-0.82), and stent thrombosis (ST; HR 0.54; 0.37-0.78). OCT-guided PCI reduced MACE (HR 0.75; 0.63-0.91; P = 0.003), cardiac death (HR 0.48; 0.27-0.83), myocardial infarction (HR 0.79; 0.63-0.99), ST (HR 0.40; 0.22-0.74), and TVR (HR 0.74; 0.57-0.97). Bayesian posterior probabilities of benefit exceeded 82% for all IVUS and 94% for all OCT endpoints. Indirect comparison detected no significant between-modality difference. Meta-regression of IVUS trials revealed heterogeneity by geographic region (P < 0.001) and attenuation of benefit over time (β = +0.034/year; P = 0.004); OCT analyses were non-significant.Conclusion
Both IVUS and OCT reduced MACE, revascularization, and ST compared with angiography-guided PCI. These findings support intravascular imaging as a routine adjunct to PCI in the populations studied.
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BibTeX
@article{abdulhak2026intravascular,
title = {{Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies}},
author = {Aref A Bin Abdulhak and Mamas A Mamas and Ziad A Ali and Roxana Mehran and Wayne B Batchelor and Razan Bahurmuz and Ghulam Mujtaba Ghumman and Ala Mohsen and Khawlah A Hadi and Anas Noman and Marwan Saad and Zaher Fanari and Hazim Rahbi and Musa Sharkawi and Poghni Peri-Okonny and Raveen Chawla and Mirvat Alasnag},
journal = {European heart journal open},
year = {2026},
month = sep,
doi = {10.1093/ehjopen/oeag136},
url = {https://europepmc.org/article/PMC/PMC13717910},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies
AU - Aref A Bin Abdulhak
AU - Mamas A Mamas
AU - Ziad A Ali
AU - Roxana Mehran
AU - Wayne B Batchelor
AU - Razan Bahurmuz
AU - Ghulam Mujtaba Ghumman
AU - Ala Mohsen
AU - Khawlah A Hadi
AU - Anas Noman
AU - Marwan Saad
AU - Zaher Fanari
AU - Hazim Rahbi
AU - Musa Sharkawi
AU - Poghni Peri-Okonny
AU - Raveen Chawla
AU - Mirvat Alasnag
PY - 2026
DA - 2026/09/01
JO - European heart journal open
DO - 10.1093/ehjopen/oeag136
UR - https://europepmc.org/article/PMC/PMC13717910
AB - Aims Uncertainty persists regarding the comparative efficacy of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) vs. angiography-guided percutaneous coronary intervention (PCI). We synthesized randomized evidence using reconstructed individual participant data (IPD) and compared the two modalities indirectly.Methods and results MEDLINE and CENTRAL were searched up to 31 March 2026. IPD were reconstructed from published Kaplan-Meier curves. Primary analyses used one-stage stratified Cox models; secondary analyses included random-effects and Bayesian hierarchical models. The primary outcome was major adverse cardiovascular events (MACE). Twenty-three randomized controlled trials enrolling 21 176 patients were included (16 IVUS, N = 15 209; 7 OCT, N = 5967). IVUS-guided PCI reduced MACE [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.67-0.83; P < 0.001], target-vessel revascularization (TVR; HR 0.70; 0.60-0.82), and stent thrombosis (ST; HR 0.54; 0.37-0.78). OCT-guided PCI reduced MACE (HR 0.75; 0.63-0.91; P = 0.003), cardiac death (HR 0.48; 0.27-0.83), myocardial infarction (HR 0.79; 0.63-0.99), ST (HR 0.40; 0.22-0.74), and TVR (HR 0.74; 0.57-0.97). Bayesian posterior probabilities of benefit exceeded 82% for all IVUS and 94% for all OCT endpoints. Indirect comparison detected no significant between-modality difference. Meta-regression of IVUS trials revealed heterogeneity by geographic region (P < 0.001) and attenuation of benefit over time (β = +0.034/year; P = 0.004); OCT analyses were non-significant.Conclusion Both IVUS and OCT reduced MACE, revascularization, and ST compared with angiography-guided PCI. These findings support intravascular imaging as a routine adjunct to PCI in the populations studied.
SN - 2752-4191
ER -