Meta-analysis finds intravascular imaging reduces MACE in older PCI patients

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Coronary artery disease Published May 2, 2026 Medically reviewed May 8, 2026 Study authors: Ezenna Chidubem, Ibrahim Sammudeen, Ismayl Mahmoud, Murali Krishna Mrinal, Chi Kuan-Yu, Joseph Meghn… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider intravascular imaging, especially IVUS, to reduce MACE in older PCI patients.

This is a meta-analysis of randomized controlled trials in adults aged 65 years or older undergoing percutaneous coronary intervention. The scope was to compare intravascular imaging guidance (IVUS or OCT) with angiography alone for major adverse cardiovascular events at longest follow-up.

The authors synthesized data from 7164 patients. Intravascular imaging significantly reduced MACE compared with angiography alone (RR 0.66, 95% CI 0.56-0.77, P < 0.001, I² = 0%). The IVUS subgroup showed superiority (RR 0.55, 95% CI 0.43-0.72, P < 0.001), while the OCT subgroup showed only a trend toward reduction (RR 0.80, 95% CI 0.62-1.02). Benefits were consistent in complex lesions (RR 0.65, 95% CI 0.53-0.79, P < 0.001).

The authors note low heterogeneity and consistent results across subgroups, supporting high certainty. Limitations were not reported in the abstract. Safety data were not reported.

Practice relevance is that intravascular imaging, especially IVUS, may reduce events in older adults undergoing PCI compared with angiography alone. This is an association from pooled trials, not direct causation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up780.0 mo

PublishedMay 2026

PMID41176629

View Original Abstract ↓

BACKGROUND: Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults. METHODS: Cochrane, PubMed, and Scopus were searched for RCTs comparing intravascular imaging (IVUS or OCT) vs. angiography alone in adults aged ≥65 years. The outcome of interest was major adverse cardiovascular events (MACE) at the longest follow-up, as defined by each trial. Subgroup analyses were performed based on intravascular imaging modality, age group, and lesion complexity. Data were pooled using random-effects models, and heterogeneity was assessed using Higgins' I ² statistic. RESULTS: Nine RCTs ( n = 7164, intravascular imaging = 3703, angiography alone = 3461) met the inclusion criteria. Intravascular imaging significantly reduced MACE compared with angiography alone [relative risk (RR) 0.66, 95% confidence interval (CI) 0.56-0.77; P < 0.001; I ² = 0%]. IVUS demonstrated superiority over angiography alone (RR 0.55, 95% CI 0.43-0.72; P < 0.001; I ² = 0%), while OCT demonstrated only a trend toward MACE reduction (RR 0.80, 95% CI 0.62-1.02). Subgroup analyses indicated consistent benefits with intravascular imaging for adults aged ≥65 and ≥70 years, respectively, and among those with complex coronary lesions (RR 0.65, 95% CI 0.53-0.79; P < 0.001). CONCLUSION: Intravascular imaging guidance, especially IVUS, reduces MACE in older adults undergoing PCI compared with angiography alone.