Impact of IVUS on Long-Term Outcomes in AMI

Quick Takes

  • IVUS-guided PCI was associated with improved long-term clinical outcomes compared to angiography-only PCI among patients with AMI.
  • Subgroup analysis from this study suggests increased benefit of IVUS use among AMI patients undergoing left main PCI and those with chronic renal failure.

Study Questions:

What is the impact of intravascular ultrasound (IVUS) on long-term clinical outcomes among patients with acute myocardial infarction (AMI)?

Methods:

All patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) (n = 9,846) were selected from the multicenter AMI registry. Patients were classified into the IVUS-guided group (n = 2,032) or angiography-guided PCI group (n = 7,814). The primary outcome was a composite of major adverse cardiac events (MACE), including cardiovascular death, MI, and target lesion revascularization during long-term follow-up.

Results:

IVUS-guided PCI was associated with reduced MACE (hazard ratio [HR], 0.779; 95% confidence interval [CI], 0.689-0.880; p < 0.001). The results were consistent after multivariable regression and propensity score matching. One-year landmark analysis showed a lower risk of MACE within 1 year (HR, 0.766; 95% CI, 0.650-0.903; p = 0.002) and beyond 1 year (HR, 0.796; 95% CI, 0.663-0.956; p = 0.014) after the index PCI.

Conclusions:

The use of IVUS is associated with better long-term cardiovascular outcomes. The clinical benefit of IVUS was maintained both within and beyond 1 year after the index PCI. The use of IVUS in PCI should be considered for patients with AMI.

Perspective:

IVUS-guided PCI was associated with improved clinical outcomes compared to angiography-only PCI among patients with AMI. Barring the limitations of this retrospective analysis from a registry, findings from this study are consistent with prior reports showing the advantage of IVUS to guide PCI and show impact on important long-term clinical outcomes in patients with AMI. Subgroup analysis from this study suggests enhanced benefit of IVUS use among AMI patients undergoing left main PCI and those with chronic renal failure. This simple and safe tool should be considered to guide PCI, especially among patients with AMI.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and ACS, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Coronary Angiography, Drug-Eluting Stents, Kidney Failure, Chronic, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Ultrasonography, Ultrasonography, Interventional


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