ScholarWorks@중앙대학교

초록

BACKGROUND: Intravascular imaging improves percutaneous coronary intervention (PCI) outcomes, but its effect according to diabetes status remains insufficiently defined. METHODS: PubMed, Embase, and CENTRAL were systematically searched for randomized trials comparing intravascular imaging- versus angiography-guided PCI, or optical coherence tomography (OCT) versus intravascular ultrasound (IVUS), reporting outcomes by diabetes status. The primary outcome was target vessel failure (TVF) at &#x2265;1-year. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated from event counts using a random-effects model. RESULTS: Eleven RCTs (n=17,692) were included. Intravascular imaging-guided PCI reduces TVF compared with angiography guidance, with consistent effects in patients with diabetes (RR 0.69, 95% CI 0.53-0.90; P=0.006) and without diabetes (RR 0.65, 95% CI 0.55-0.77; P<0.001; P-interaction=0.72). Similar reductions were observed in complex PCI populations and with both IVUS and OCT guidance. In diabetic patients undergoing complex PCI, intravascular imaging likely reduces TVF (RR 0.74, 95% CI 0.53-1.04), while OCT guidance may reduce TVF (RR 0.70, 95% CI 0.42-1.16). In exploratory head-to-head analyses, OCT showed no difference in TVF risk compared with IVUS, with consistent findings across diabetes status. Meta-regression identified age and follow-up duration as potential effect modifiers in patients with diabetes. CONCLUSIONS: Intravascular imaging-guided PCI reduces TVF compared with angiography guidance in both patients with and without diabetes. In some diabetic subgroups, intravascular imaging likely or may reduce TVF, although estimates were imprecise. These findings support intravascular imaging to optimize PCI outcomes regardless of diabetes status. (word count = 243). Copyright © 2026. Published by Elsevier Inc.

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