A comprehensive network meta-analysis: comparison of long-term outcomes between intravascular ultrasound, optical coherence tomography, and angiography-guided stent implantation

Abstract

Abstract Background Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided stent implantations are alternative techniques that are adjunct to angiography-guided (ANG) percutaneous coronary interventions in patients with coronary artery disease (CAD), especially for optimal stent deployment. We aimed to conduct a network meta-analysis including studies comparing those three techniques. Methods We searched PubMed, Scopus, and Cochrane libraries for eligible studies that compared IVUS, OCT, and angiography-guided stent implantation in patients with CAD. After excluding studies, which were irrelevant, duplicated, and had inappropriate results, 54 randomized, propensity-score matched, and observational studies with 232.181 patients were included in this meta-analysis. Results Number of studies compared ANG and IVUS was higher than the other two comparisons. Indirect evidence of network estimates between OCT and IVUS was higher than direct estimate (60% vs. 40%). Minimal parallelism and mean path length of each estimation was suitable with numbers low than 2 for both for comparisons. ANG had higher MACE (RR =1.30; 1.22-1.39, p<0.001), all cause-death (RR=1.45;1.30-1.61, p<0.001), cardiac death (RR=1.72;1.54-1.92, p<0.001), myocardial infarction (RR=1.34; 1.23-1.45, p<0.001), target lesion revascularization (RR=1.20; 1.13-1.26, p<0.001), and stent thrombosis (RR=1.58;1.34-1.85, p<0.001) risks compared to IVUS. There was no difference between OCT and IVUS regarding all outcomes. MACE (RR=1.51;1.26-1.81, p<0.001), cardiac death (RR=2.13;1.41-3.21, p<0.001), and myocardial infarction (RR=1.42;1.05-1.93, p<0.001) risks were higher in ANG groups than in OCT group. Highest benefit was established with OCT for MACE (p-score = 0.973), with IVUS for all-cause death (p-score= 0.792), with OCT for cardiac death (p-score=0.921), with OCT for myocardial infarction (p-score =0.823), with IVUS for target lesion revascularization (p-score=0.865), and with IVUS for stent thrombosis (p-score=0.930). Heterogeneity was appropriate for all outcomes (I2 <70%). There was no publication bias for all outcomes. Conclusion This comprehensive network meta-analysis indicated that angiography-guided stent implantation had higher risk of MACE, cardiac death, myocardial infarction, target lesion-revascularization, and stent thrombosis when compared to IVUS and had higher risk of MACE, cardiac death, and myocardial infarction than OCT.