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Background:
Systematic Review

Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials

by
Hesham E. Mawar
1,2,*,
Maryam Baamer
1,2,
Azzam A. Althagafi
1,2,
Ahmad G. Alghamdi
1,2,
Moudi Aleidi
1,2,
Reem S. Alzahrani
1,2,
Abdulrahman Alnamlah
1,2,
Maya F. Bokhari
1,2,
Amjaad Batawi
1,2,
Mohammed F. Gholam
1,2 and
Saad Al Bugami
2,3
1
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
2
King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
3
Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia
*
Author to whom correspondence should be addressed.
Diagnostics 2026, 16(9), 1317; https://doi.org/10.3390/diagnostics16091317
Submission received: 23 February 2026 / Revised: 21 March 2026 / Accepted: 17 April 2026 / Published: 28 April 2026
(This article belongs to the Special Issue Expanding Horizons: Optical Coherence Tomography in Cross-Specialty Diagnostic Practice)
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Abstract

Background: Moderate-to-severe coronary calcification is associated with worse outcomes following percutaneous coronary intervention (PCI). We aimed to assess the safety and efficacy of optical coherence tomography (OCT) compared with conventional angiography in PCI guidance of moderate-to-severe calcified coronary artery lesions. Methods: Multiple databases were systematically searched for outcomes of OCT- versus angiography-guided PCI in calcified lesions. Study selection and data extraction were conducted in accordance with the PRISMA guidelines. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven target vessel revascularization (ID-TVR). Secondary endpoints included clinical (i.e., TVF components, stent thrombosis, and 30-day major adverse cardiovascular events [MACEs]), imaging, and procedural outcomes. Results: Four randomized controlled trials involving 3186 participants were included. Compared with angiography, OCT was associated with a significant reduction in TVF (risk ratio [RR] = 0.66; 95% confidence interval [CI]: 0.52–0.82), cardiac death (RR = 0.39; 95% CI: 0.22–0.70), TV-MI (RR = 0.63; 95% CI: 0.42–0.94), and stent thrombosis (RR = 0.24; 95% CI: 0.08–0.72). However, there were no significant changes in ID-TVR (RR = 0.77; 95% CI: 0.55–1.08) or 30-day MACEs (RR = 0.50; 95% CI: 0.16–1.61). Most procedural outcomes varied across studies and showed significant heterogeneity. Conclusions: OCT-guided PCI was associated with better clinical outcomes compared with angiography-guided PCI in this patient population. However, larger randomized trials are needed to confirm these results.
Keywords: coronary artery calcification; coronary artery disease; optical coherence tomography; percutaneous coronary intervention coronary artery calcification; coronary artery disease; optical coherence tomography; percutaneous coronary intervention

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MDPI and ACS Style

Mawar, H.E.; Baamer, M.; Althagafi, A.A.; Alghamdi, A.G.; Aleidi, M.; Alzahrani, R.S.; Alnamlah, A.; Bokhari, M.F.; Batawi, A.; Gholam, M.F.; et al. Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials. Diagnostics 2026, 16, 1317. https://doi.org/10.3390/diagnostics16091317

AMA Style

Mawar HE, Baamer M, Althagafi AA, Alghamdi AG, Aleidi M, Alzahrani RS, Alnamlah A, Bokhari MF, Batawi A, Gholam MF, et al. Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials. Diagnostics. 2026; 16(9):1317. https://doi.org/10.3390/diagnostics16091317

Chicago/Turabian Style

Mawar, Hesham E., Maryam Baamer, Azzam A. Althagafi, Ahmad G. Alghamdi, Moudi Aleidi, Reem S. Alzahrani, Abdulrahman Alnamlah, Maya F. Bokhari, Amjaad Batawi, Mohammed F. Gholam, and et al. 2026. "Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials" Diagnostics 16, no. 9: 1317. https://doi.org/10.3390/diagnostics16091317

APA Style

Mawar, H. E., Baamer, M., Althagafi, A. A., Alghamdi, A. G., Aleidi, M., Alzahrani, R. S., Alnamlah, A., Bokhari, M. F., Batawi, A., Gholam, M. F., & Al Bugami, S. (2026). Optical Coherence Tomography-Guided Versus Angiography-Guided PCI in Moderate-to-Severe Calcified Coronary Lesions: A Systematic Review and Meta-Analysis of Randomized Trials. Diagnostics, 16(9), 1317. https://doi.org/10.3390/diagnostics16091317

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