Nabila Mahdi, Aisha Matar
Interventional Cardiology Perspectives - 2025;1(3):87-97
Background: Complex percutaneous coronary intervention (PCI) presents technical challenges and elevated procedural risks. Coronary computed tomography angiography (CCTA) is a non-invasive imaging modality that might improve pre-procedural planning and intra-procedural guidance. Aim: This study evaluates the impact of CCTA-guided PCI compared with standard angiography guidance in complex PCI, with a focus on procedural success, fluoroscopy time, contrast volume, and major adverse cardiac events (MACE). Study Design: A systematic review and meta-analysis. Methods: We conducted a systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Google Scholar, and ClinicalTrials.gov for studies published between 2014 and 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing CCTA-guided versus angiography-guided PCI in adults. Outcomes were pooled using random-effects meta-analysis. The certainty of evidence was assessed using the GRADE framework. Results: Five studies (one RCT, four observational; 7,406 participants), all focusing on chronic total occlusion PCI, were included. Meta-analyses revealed no significant differences in procedural success [risk ratio: 0.97, 95% confidence interval (CI): 0.92-1.02], fluoroscopy time [mean difference (MD) +6.0 min, 95% CI: -7.7 to 19.7], or contrast volume (MD -7.0 mL, 95% CI -43.5 to 29.4). MACE rates were also comparable (odds ratio: 1.03, 95% CI: 0.67-1.58). The certainty of evidence was rated as very low due to risk of bias, imprecision, heterogeneity, and limited generalizability. Conclusion: CCTA-guided PCI is comparable to angiography-guided PCI in terms of procedural success, efficiency, and safety in complex lesions. However, the very low certainty of evidence and reliance on non-randomized studies limit definitive conclusions. High-quality RCTs are required to elucidate the clinical role of CCTA in guiding complex PCI.
