Abstract Body (Do not enter title and authors here): Background: Angiography has been the standard for imaging guidance during the Percutaneous Coronary Intervention (PCI) in patients with Myocardial Infarction. Intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) are the emerging techniques for guiding the PCI for better patient outcomes. However, there is still limited data on the impact of OCT on clinical outcomes compared to IVUS or angiography-guided PCI. We conducted a systemic review and meta-analysis of all the available randomized control trials comparing OCT-guided vs Angiography-guided or IVUS-guided PCI.

Methods: PubMed and Cochrane Library were searched from their inception till September 2023 for all the randomized control trials (RCTs) that compared the clinical outcomes between OCT-guided PCI and Angiography-guided or IVUS-guided PCI. The outcomes of interest extracted from the finalized trials were minimal stent area (MSA), all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACE), target vessel revascularization (TVR), myocardial infarction (MI), target lesion revascularization (TLR) and Stent thrombosis (ST). The trial results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a random effects model.

Results: A significant increase in MSA was observed in OCT-guided stent implantation as compared to angiographic-guided stent implantation [MD: 0.36 (0.22, 0.50); P< 0.00001]. There was a significant reduction in stent thrombosis events by OCT-guided procedures when compared with Angiography-guided procedures [RR: 0.52 (0.32, 0.83); P= 0.006].

There was no significant difference observed in all-cause mortality [RR: 0.92 (0.47, 1.78); P= 0.80], cardiovascular mortality [RR: 0.73 (0.24, 2.21); P= 0.58], and MI [RR: 1.26 (0.52, 3.02); P= 0.61] between OCT guided and IVUS guided PCI.

Conclusion: In this meta-analysis, OCT-guided procedures demonstrated superior outcomes in terms of achieving a larger minimal stent area (MSA) and reducing the risk of stent thrombosis compared to angiography-guided PCI. While no significant differences were found between OCT-guided and IVUS-guided PCI, OCT's ability to optimize stent implantation is a valuable addition to traditional angiographic guidance, and advocates further research to address procedural complexities and confirm its clinical benefits.