Three-dimensional versus two-dimensional quantitative coronary angiography for coronary lesion assessment: a systematic review and meta-analysis
Recommended Citation
Gupta P, Vempati R, Alwifati N, Fahed J, Hamza M, Rab AU, Mahmoud AA, Patel M, Eisa A, Zoma M, Nakarmi P, Burhan M, Haider MZ, Naeem A, Korucu BC, Hajeh H, Gopal S, Zulaid A, Khoury I, Mahmood A, Ramchandran SP, Alraies MC. Three-Dimensional Versus Two-Dimensional Quantitative Coronary Angiography for Coronary Lesion Assessment: A Systematic Review and Meta-Analysis. J Thromb Thrombolysis. 2026.
Document Type
Article
Publication Date
8-11-2026
Publication Title
Journal of thrombosis and thrombolysis
Abstract
Accurate anatomical assessment of coronary lesions is fundamental to effective percutaneous coronary intervention (PCI). Conventional two-dimensional quantitative coronary angiography (2D-QCA) is limited by projection dependency, vessel overlap, and foreshortening, leading to imprecise estimation of lesion severity. Three-dimensional quantitative coronary angiography (3D-QCA), based on 3D reconstruction, provides more accurate vessel assessment than 2D analysis; however, its reported advantages remain inconsistent across studies. We conducted a systematic review and meta-analysis in accordance with PRISMA and Cochrane guidelines. PubMed, Embase, Scopus, and Cochrane Central were searched from inception to October 2025 for studies comparing 3D-QCA with 2D-QCA using validated software. Random-effects models pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using ROB-2 and the Newcastle-Ottawa Scale. Sixteen studies were included. Compared with 2D-QCA, 3D-QCA reported significantly longer lesion length (SMD 0.29; 95% CI 0.04-0.53) and larger minimal luminal area (SMD 0.36; 95% CI 0.07-0.65). Diameter stenosis (SMD - 0.28; 95% CI - 0.48 to - 0.07) and percent stenosis (SMD - 0.57; 95% CI - 0.95 to - 0.20) were lower with 3D-QCA. No significant differences were observed for bifurcation angle, minimal luminal diameter, reference vessel diameter, or reference vessel area. Moderate-to-high heterogeneity was observed across outcomes. 3D-QCA provides more precise anatomical characterization of coronary lesions than conventional 2D-QCA, particularly for lesion length and area-based metrics, supporting its role in improving PCI planning, while further outcome-driven studies are needed.
PubMed ID
42579059
ePublication
ePub ahead of print
