Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Bristol Heart Institute, Bristol, United Kingdom.
Rev Esp Cardiol (Engl Ed). 2023 Aug;76(8):589-599. doi: 10.1016/j.rec.2022.10.006. Epub 2022 Oct 26.
Evidence for the role of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients at high ischemic risk of acute myocardial infarction (AMI) is lacking. This study aimed to investigate the long-term clinical impact of IVUS-guided PCI in patients at high ischemic risk of AMI.
Among 13 104 patients with AMI enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we selected 8890 patients who underwent successful PCI with second-generation drug-eluting stent implantation and classified them into 2 groups based on whether or not they were at high ischemic risk or not, defined as any of the following: number of stents implanted ≥ 3, 3 vessels treated, ≥ 3 lesions treated, total stent length> 60mm, left main PCI, diabetes mellitus, and chronic kidney disease. The primary outcome was target lesion failure including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years.
In 4070 AMI patients at high ischemic risk, IVUS-guided PCI (21.6%) was associated with a significantly lower risk of target lesion failure at 3 years (6.7% vs 12.0%; HR, 0.54; 95%CI, 0.41-0.72; P <.001) than angiography-guided PCI. The results were consistent after confounder adjustment, inversed probability weighting, and propensity score matching.
In patients at high ischemic risk of AMI who underwent PCI with second-generation drug-eluting stent implantation, use of IVUS guidance was associated with a significant reduction in 3-year target lesion failure. iCreaT study No. C110016.
在急性心肌梗死（AMI）高缺血风险患者中，血管内超声（IVUS）指导的经皮冠状动脉介入治疗（PCI）的作用证据不足。本研究旨在探讨 IVUS 指导的 PCI 在 AMI 高缺血风险患者中的长期临床影响。
在韩国急性心肌梗死注册-美国国立卫生研究院登记的 13104 例 AMI 患者中，我们选择了 8890 例接受成功的第二代药物洗脱支架植入 PCI 的患者，并根据是否存在高缺血风险将其分为两组，定义为以下任何一种情况：植入支架数量≥3、处理 3 支血管、≥3 个病变处理、总支架长度>60mm、左主干 PCI、糖尿病和慢性肾脏病。主要结局是 3 年时的靶病变失败，包括心源性死亡、靶血管心肌梗死和缺血驱动的靶病变血运重建。
在 4070 例 AMI 高缺血风险患者中，IVUS 指导的 PCI（21.6%）与 3 年时靶病变失败的风险显著降低相关（6.7%比 12.0%；HR，0.54；95%CI，0.41-0.72；P<.001），与血管造影指导的 PCI 相比。在混杂因素调整、逆概率加权和倾向评分匹配后，结果仍然一致。
在接受第二代药物洗脱支架植入 PCI 的 AMI 高缺血风险患者中，使用 IVUS 指导与 3 年靶病变失败显著降低相关。iCreaT 研究号 C110016。
