Intravascular modality‐guided versus angiography‐guided percutaneous coronary intervention in acute myocardial infarction

Abstract

Background Few data are available for current usage patterns of intravascular modalities such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) in acute myocardial infarction (AMI). Moreover, patient and procedural‐based outcomes related to intravascular modality guidance compared to angiography guidance have not been fully investigated yet. Methods We examined 11,731 patients who underwent percutaneous coronary intervention (PCI) from the Korea AMI Registry–National Institute of Health database. Patient‐oriented composite endpoint (POCE) was defined as all‐cause death, any infarction, and any revascularization. Device‐oriented composite endpoint (DOCE) was defined as cardiac death, target‐vessel reinfarction, and target‐lesion revascularization. Results Overall, intravascular modalities were utilized in 2,659 (22.7%) patients including 2,333 (19.9%) IVUS, 277 (2.4%) OCT, and 157 (1.3%) FFR. In the unmatched cohort, POCE (5.4 vs. 8.5%; adjusted hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.61–0.93; p = .008) and DOCE (4.6 vs. 7.4%; adjusted HR 0.77; 95% CI 0.61–0.97; p = .028) were significantly lower in intravascular modality‐guided PCI compared with angiography‐guided PCI. In the propensity‐score‐matched cohorts, POCE (5.9 vs. 7.7%; HR 0.74; 95% CI 0.60–0.92; p = .006) and DOCE (5.0 vs. 6.8%; HR 0.72; 95% CI 0.57–0.90; p = .004) were significantly lower in intravascular modality guidance compared with angiography guidance. The difference was mainly driven by reduced all‐cause mortality (4.4 vs. 7.0%; p < .001) and cardiac mortality (3.3 vs. 5.2%; p < .001). Conclusion In this large‐scale AMI registry, intravascular modality guidance was associated with an improving clinical outcome in selected high‐risk patients.

Intravascular ultrasound-guided versus coronary angiography-guided percutaneous coronary intervention in patients with acute myocardial infarction: A systematic review and meta-analysis

“…After full-text evaluation of 39 potentially eligible records, 9 studies were included in the systematic review and meta-analysis (Fig. 1) [12,13,[21][22][23][24][25][26][27]. One eligible record was excluded because the study population was also part of a larger included study by Ya'qoub et al [26,28]…”

“…2). For MACE, study heterogeneity was mainly caused by the large study of Kim et al, favoring IVUS with a lower RR as compared to other studies [22].…”

Impact of intracoronary imaging on in‐hospital mortality and 30‐day readmission rates following percutaneous coronary intervention: A nationwide readmissions database analysis

“…This present study found that the odds of having an in‐hospital death is statistically lower in patients with intracoronary imaging‐guided PCI compared to angiography‐guided PCI. Other registry data support these findings, which also show intracoronary imaging have better outcomes compared to angiography‐alone PCI, regardless whether the imaging occurred with IVUS 13 or OCT 14 . All‐cause mortality was the driving factor for improved outcomes in both these registries.…”

“…However, p < .001), we were able to use univariate (Figure 3) and multivariate analysis (Figure 4) to examine for other predictors of in-hospital mortality with imaging-guided PCI as outlined in This present study found that the odds of having an in-hospital death is statistically lower in patients with intracoronary imagingguided PCI compared to angiography-guided PCI. Other registry data support these findings, which also show intracoronary imaging have better outcomes compared to angiography-alone PCI, regardless whether the imaging occurred with IVUS 13 or OCT. 14 All-cause mortality was the driving factor for improved outcomes in both these registries. When comparing the imaging modalities directly against each other in the Pan-London (United Kingdom) PCI Registryafter propensity matching -there was no difference in OCT and IVUS outcomes; however, both continued to demonstrate improved mortality against angiography-alone.…”

Invasive imaging of myocardial infarction patients: Is less or more better?

“…In this issue of Catheterization and Cardiovascular Interventions , Kim et al reviewed data from the Korean AMI registry (KAMIR) and concluded that intravascular guidance with imaging, intravascular ultrasound (IVUS), opticalcoherence tomography (OCT), or FFR was associated with improved clinical outcome . Findings from KAMIR were previously reported by Ahmed et al in 2,127 patients who received IVUS, and IVUS was not predictive of improved outcome .…”