Impact of Intravascular Ultrasound on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction,JACC: Cardiovascular Interventions

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Impact of Intravascular Ultrasound on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction
JACC: Cardiovascular Interventions ( IF 11.3 ) Pub Date : 2021-10-27 , DOI: 10.1016/j.jcin.2021.08.021
Ik Jun Choi ₁ , Sungmin Lim ₂ , Eun Ho Choo ₃ , Byung-Hee Hwang ₃ , Chan Joon Kim ₄ , Mahn-Won Park ₅ , Jong-Min Lee ₄ , Chul Soo Park ₆ , Hee Yeol Kim ₇ , Ki-Dong Yoo ₈ , Doo Soo Jeon ₉ , Ho Joong Youn ₃ , Wook-Sung Chung ₃ , Min Chul Kim ₁₀ , Myung Ho Jeong ₁₀ , Youngkeun Ahn ₁₀ , Kiyuk Chang ₁₁

Affiliation

Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, St. Vincent's hospital, The Catholic University of Korea, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea.
Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Objectives

The aim of this study was to examine the impact of intravascular ultrasound (IVUS)–guided percutaneous coronary intervention (PCI) on long-term clinical outcomes in patients with acute myocardial infarction (AMI).

Background

IVUS-guided PCI has been associated with improved cardiovascular outcomes. However, the beneficial effect of IVUS-guided PCI in patients with AMI in the drug-eluting stent era remains unclear.

Methods

Patients who underwent PCI with drug-eluting stents were selected from 10,719 patients enrolled in a multicenter AMI registry. The included patients were classified into 2 groups according to the use or nonuse of IVUS. The primary outcome was a composite of major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and target lesion revascularization, during long-term follow-up.

Results

A total of 9,846 patients were treated with IVUS-guided PCI (n = 2,032) or angiography-guided PCI (n = 7,814). IVUS-guided PCI was associated with reduced MACE (HR: 0.779; 95% 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 for MACE within 1 year (HR: 0.766; 95% CI: 0650-0.903; P = 0.002) and beyond 1 year (HR: 0.796; 95% CI: 0663-0.956; P = 0.014) after index PCI.

Conclusions

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

中文翻译：

血管内超声对急性心肌梗死患者长期临床结局的影响

目标

本研究旨在探讨血管内超声 (IVUS) 引导下的经皮冠状动脉介入治疗 (PCI) 对急性心肌梗死 (AMI) 患者长期临床结局的影响。

背景

IVUS 引导的 PCI 与改善心血管结局相关。然而，在药物洗脱支架时代，IVUS 引导的 PCI 对 AMI 患者的有益效果仍不清楚。

方法

接受药物洗脱支架 PCI 的患者选自多中心 AMI 登记的 10,719 名患者。根据是否使用IVUS将纳入的患者分为2组。主要结局是长期随访期间主要不良心血管事件 (MACE) 的复合结果，包括心血管死亡、心肌梗死和靶病变血运重建。

结果

共有 9,846 名患者接受了 IVUS 引导的 PCI (n = 2,032) 或血管造影引导的 PCI (n = 7,814) 的治疗。IVUS 引导的 PCI 与 MACE 减少相关（HR：0.779；95% CI：0.689-0.880；P < 0.001）。多变量回归和倾向评分匹配后的结果是一致的。一年里程碑分析显示，1 年内（HR：0.766；95% CI：0650-0.903；P = 0.002）和 1 年后（HR：0.796；95% CI：0663-0.956；P = 0.014) 在指数 PCI 之后。