Impact of Intra-Coronary Optical Coherence Tomography Compared to Intravascular Ultrasound and Coronary Angiography on Contrast-Induced Nephropathy in Coronary Intervention: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Meta-analyses have examined optical coherence tomography (OCT)-, intravascular ultrasound (IVUS)-, and angiography-guided drug-eluting stent (DES) implantation for target lesion revascularization and major adverse cardiovascular events. However, contrast-induced nephropathy (CIN), especially with the additional contrast used in OCT, has not been evaluated in a meta-analysis of randomized studies. METHODS PubMed, Scopus, and EMBASE were searched through May 2025 for randomized controlled trials (RCTs) comparing OCT-, IVUS-, and angiography-guided DES implantation. The primary outcome was CIN. Studies were screened with predefined criteria, duplicates removed, and risk of bias assessed with the Cochrane RoB 2 tool. Analyses used random-effects models in RStudio, with I 2 assessing heterogeneity. RESULTS Of 654 studies, seven RCTs (6,459 participants) were included. Most excluded patients with advanced chronic kidney disease not on dialysis. Seven RCTs (3,166 participants) reported CIN in the OCT-guided group, with a pooled incidence of 0.5% (95% CI: 0.0-1.5%). Four RCTs comparing OCT- vs angiography-guided groups showed no difference (RR: 1.40; 95% CI: 0.61-3.23; p=0.85). Four RCTs comparing OCT- vs IVUS-guided groups also showed no difference (RR: 0.88; 95% CI: 0.44-1.76; p=0.61). CONCLUSION Despite higher contrast use, OCT-guided DES implantation was not associated with greater CIN risk than angiography- or IVUS-guided groups in patients without severe CKD.

Volume

87

Issue

13 Suppl

First Page

A418

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A419

DOI

10.1016/j.jacc.2026.02.1028

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