IVUS-guided PCI yields better long-term CV outcomes in acute MI
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Among patients receiving PCI with a drug-eluting stent, use of IVUS was associated with better CV outcomes, both within and beyond 1 year after the index procedure, according to new research.
For the study, published in JACC: Cardiovascular Interventions, Ik Jun Choi, MD, PhD, of Incheon St. Mary’s Hospital in Seoul, South Korea, and colleagues aimed to better understand the beneficial effect of IVUS-guided PCI in patients with acute MI in the DES era, which, they wrote, remains unclear. They chose patients who received PCI with DES from the 10,719 patients enrolled in the multicenter COREA-AMI registry, classifying them by whether IVUS was used during their procedure.
A composite of MACE, including CV death, MI and target lesion revascularization during long-term follow-up, served as the primary outcome.
In all, 9,846 patients (mean age, 63 years; 72% men) received either IVUS-guided PCI (n = 2,032) or angiography-guided PCI (n = 7,814).
Results indicated that those receiving IVUS-guided PCI demonstrated a reduction in MACE (HR = 0.779; 95% CI, 0.689-0.88; P < .001), findings consistent after multivariable regression and propensity-score matching.
In 1-year landmark analysis, the risk for MACE with IVUS-guided PCI was reduced within 1 year (HR = 0.766; 0.65-0.903; P = .002) and beyond 1 year (HR = 0.796; 0.663-0.956; P = .014) after index PCI.
“IVUS can be safely used without increasing procedural complications in the setting of the procedure for acute MI, and patients with acute MI who were treated by IVUS-guided PCI had a higher number, larger diameter and longer length of stents,” Choi and colleagues wrote. “IVUS-guided PCI was independently associated with a decreased risk of long-term cardiovascular events in patients with acute MI undergoing PCI with a DES. The beneficial effects of IVUS persisted for more than 1 year after the index PCI. The use of IVUS in PCI should be considered for patients with acute MI.”
In an accompanying editorial, Yasuhiro Honda, MD, director of the Stanford Core Analysis Laboratory and clinical professor of medicine (cardiovascular medicine) at Stanford University School of Medicine, commended the researchers for their effort drawing meaningful insights from a large real-world observational database.
“As the body of evidence in this arena has nearly matured with consistent results supporting the clinical benefit and cost-effectiveness of IVUS-guided PCI, further designing mega-scale randomized controlled trials to merely confirm the advantage of IVUS guidance for each complex lesion/high-risk patient subset would not be warranted anymore,” Honda wrote. “Future efforts should rather be directed towards the establishment of standardized workflow to maximize the benefit of image guidance in various lesion/patient subsets.”
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