Abstract Body (Do not enter title and authors here): Background: Data regarding clinical outcomes after optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI in patients with coronary artery lesions are limited.

Methods: We systematically searched PubMed, Embase and Cochrane library for randomized controlled trials (RCTs) comparing the impact of OCT-guided PCI versus Angiography-guided PCI on clinical outcomes in patients with coronary artery lesions with primary outcome of interest being all-cause mortality. The secondary outcomes include major adverse cardiovascular events (MACE), stroke, stent thrombosis, bleeding, target vessel revascularization (TVR), target lesion revascularization (TLR), cardiovascular death and myocardial infarction (MI). We pooled risks ratio and their 95% confidence intervals. Heterogeneity was examined using the I² statistics and studies with high heterogeneity were examined using the random-effect model.

Results: We included 10 RCTs consisting of 8729 patients of which 4256 (48.8%) patients had OCT-guided PCI treatment while 4473 (51.2%) patients had angiography-guided PCI treatment. The mean age of the included studies was 64 ± 10.2 years and 82.6% of the included studies were males. The pooled risks ratio showed no significant differences between groups for all-cause mortality (RR = 0.71; 95% CI [0.50, 1.01]; I² = 0%; p = 0.05), stroke (RR = 0.06; 95% CI [0.08, 4.51]; I² = 52%; p = 0.62), bleeding (RR = 0.70; 95% CI [0.21, 2.35]; I² = 0%; p = 0.56), TLR (RR = 0.75; 95% CI [0.45, 1.23]; I² = 49%; p = 0.26), TVR (RR = 0.78; 95% CI [0.59, 1.02]; I² = 0%; p = 0.07) and MI (RR = 0.82; 95% CI [0.67, 1.01]; I² = 0%; p = 0.06).

However, OCT-guided PCI significantly reduced the incidence of MACE (RR = 0.70; 95% CI [0.56, 0.87]; I² = 0%; p = 0.002), stent thrombosis (RR = 0.61; 95% CI [0.39, 0.94]; I² = 0%; p = 0.02) and cardiovascular death (RR = 0.54; 95% CI [0.35, 0.83]; I² = 0%; p = 0.005) compared to angiography-guided PCI.

Conclusions: Among patients with coronary artery lesions, OCT-guided PCI was associated with lower incidence of MACE, stent thrombosis and cardiovascular death. However, there was no significant difference between groups for all-cause mortality, bleeding, stroke, TVR, TLR and MI.