BACKGROUND: The role of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is still unclear in patients with acute myocardial infarction acute myocardial infarction. This study aimed to evaluate the long-term impact of IVUS-guided PCI in patients with acute myocardial infarction. METHODS AND RESULTS: Among a total of 13 104 patients with acute myocardial infarction, enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we selected patients who underwent PCI with second-generation drug-eluting stent implantation. The primary outcome was the risk of target lesion failure at 3 years. Among the study population, 1887 patients (21.0%) underwent IVUS-guidance, and 7120 patients (79.0%) underwent angiography-guidance for second-generation drug-eluting stent implantation. IVUS-guided PCI was associated with a significantly lower risk of target lesion failure at 3 years (4.8% versus 8.0%; hazard ratio [HR], 0.59; 95% CI, 0.47 to 0.73; P<0.001) compared with angiography-guided PCI. The dif-ference was driven mainly by a lower risk of cardiac death and target vessel myocardial infarction. The results were consistent after confounder adjustment by multiple sensitivity analyses. Moreover, quartile analysis of volume of IVUS use showed that higher IVUS use was associated with a decreased risk of 3-year target lesion failure (adjusted HR, 0.58; 95% CI, 0.45 to 0.75; P<0.001 for quartile 1 versus 4; P<0.001 for trend comparison across all quartiles). CONCLUSIONS: In patients with acute myocardial infarction who underwent PCI with second-generation drug-eluting stent im-plantation, the use of IVUS guidance was associated with a significant reduction in 3-year target lesion failure, mainly driven by hard end points, such as cardiac death and target vessel myocardial infarction.
|Journal||Journal of the American Heart Association|
|Publication status||Published - 2022 Mar 1|
Bibliographical noteFunding Information:
This study was supported by grant from a faculty research grant of Yonsei University College of Medicine (6-2020-0161) and research seed money grant of Internal Medicine in Yongin Severance Hospital.Disclosures Dr Johnson has received consultancy & speaker fees from Boston Scientific. The remaining authors have no disclosures to report.
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine