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.
JACC Cardiovasc Interv. 2021 Nov 22;14(22):2431-2443. doi: 10.1016/j.jcin.2021.08.021. Epub 2021 Oct 27.
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).
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.
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.
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.
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.
本研究旨在探讨血管内超声（IVUS）指导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。
IVUS 指导的 PCI 已与改善心血管结局相关。然而，在药物洗脱支架时代，IVUS 指导的 PCI 在 AMI 患者中的有益效果尚不清楚。
从多中心 AMI 注册中心入选的 10719 例接受药物洗脱支架 PCI 的患者中选择研究对象。根据是否使用 IVUS 将纳入患者分为 2 组。主要终点为长期随访期间主要不良心血管事件（MACE）的复合终点，包括心血管死亡、心肌梗死和靶病变血运重建。
共 9846 例患者接受了 IVUS 指导 PCI（n=2032）或血管造影指导 PCI（n=7814）。IVUS 指导 PCI 与 MACE 降低相关（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结果一致。1 年 landmark 分析显示，1 年内（HR：0.766；95%CI：0.650-0.903；P=0.002）和 1 年后（HR：0.796；95%CI：0.663-0.956；P=0.014）MACE 的风险较低。
IVUS 的使用与更好的长期心血管结局相关。在指数 PCI 后 1 年内和 1 年以上，IVUS 的临床获益均得以维持。对于 AMI 患者，应考虑在 PCI 中使用 IVUS。
