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
In brief
IVUS and OCT-guided PCI cut major cardiovascular events by about one-quarter
Across 23 randomized trials involving 21,176 patients, PCI guided by either intravascular ultrasound or optical coherence tomography was linked to about 25% fewer major cardiovascular events than angiography-guided PCI. The analysis found no significant difference between imaging methods, but reconstructed data and variation in IVUS benefit across regions and over time leave questions about how consistently results apply in practice.
- Journal
- European heart journal open (Q1)
- Published
- 10 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Aref A Bin Abdulhak, Mamas A Mamas, Ziad A Ali, Roxana Mehran, Wayne B Batchelor, Razan Bahurmuz, et al.
- PMID
- 42959683
- DOI
- 10.1093/ehjopen/oeag136
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 31 October 2026): Randomized evidence supports intravascular imaging-guided PCI
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.