The benefit of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) is unclear. We aimed to assess the incremental value of adding OCT to coronary angiography in PCI by meta-analytic technique. We searched PubMed, EMBASE, Cochrane, Scopus and relevant references for randomized studies (inception through January 5, 2018 without language restrictions) and performed meta-analysis using random effects model. Major adverse cardiac events (MACE), all-cause mortality, myocardial infarction, target vessel revascularization, stent thrombosis, fluoroscopic time, contrast volume, and procedural side effects were the measured outcomes. Five randomized studies with a total population of 931 were analyzed. There was no difference in MACE between angiography plus OCT and angiography alone arms (2.5 vs. 2.0% OR 1.26; 95% CI 0.40–3.99; P = 0.69; I² = 5%). Two groups were not different in terms of all-cause mortality (0.2 vs. 0% OR 3.03; 95% CI 0.12–75; P = 0.5; I² = not applicable), myocardial infarction (1 vs. 0.2% OR 2.21; 95% CI 0.39–12.49; P = 0.3; I² = 0%), target vessel revascularization (1.6 vs. 1.2% OR 1.36; 95% CI 0.4–4.4; P = 0.6; I² = 0%), and stent thrombosis (0.2 vs. 0.5% OR 0.7; 95% CI 0.11–4.51; P = 0.7; I² = 0%). OCT group had significantly higher fluoroscopic time and contrast volume. Our meta-analysis shows that the addition of OCT to angiography for PCI guidance is not associated with lower MACE, all-cause mortality, myocardial infarction, target vessel revascularization, or stent thrombosis. It is associated with longer fluoroscopic time and higher contrast volume.