Intracoronary imaging and physiology-based assessment were associated with significantly improved clinical outcomes in patients undergoing PCI. The study, published in Circulation, used a frequentist network meta-analysis of randomized controlled trials (RCTs) and provides comparative evidence across commonly applied PCI guidance strategies. 

The analysis included 80 studies encompassing 45,146 patients and evaluated coronary angiography (CA), OCT, intravascular ultrasound (IVUS), FFR, quantitative flow ratio (QFR), and instantaneous wave-free ratio (iFR). MACEs served as the primary endpoint, with risk ratios calculated using a random-effects model.

Compared with CA, IVUS (risk ratio 0.70; 95% confidence interval 0.61to–0.80), OCT (risk ratio 0.74; 95% confidence interval 0.58–0.93), and FFR (risk ratio 0.82; 95% confidence interval 0.70–0.95) reduced demonstrated lower MACE rates. IVUS, OCT, and FFR also reduced MI, while IVUS and OCT reduced cardiovascular mortality, stent thrombosis, and ischemia-driven target lesion revascularization (TLR).

The findings support the use of imaging-guided and physiology-guided strategies over CA alone when planning PCI.