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Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial
Anoop Titus1, Vidit Majmundar1, Amro Taha2
1Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
Insights
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) in non-ST-elevation myocardial infarction (NSTEMI) patients was associated with lower in-hospital mortality. However, IVUS-guided PCI also showed increased use of mechanical circulatory support without a rise in procedural complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is crucial for complex procedures.
- Evidence on IVUS use in non-ST-elevation myocardial infarction (NSTEMI) PCI outcomes is limited.
- This study investigates in-hospital outcomes comparing IVUS-guided versus non-guided PCI in NSTEMI patients.
Purpose of the Study:
- To compare in-hospital outcomes between IVUS-guided and non-guided PCI in NSTEMI hospitalizations.
- To assess the impact of IVUS guidance on mortality, mechanical circulatory support, cardiogenic shock, and procedural complications.
Main Methods:
- Utilized the National Inpatient Sample (2016-2019) database.
- Identified NSTEMI hospitalizations undergoing PCI.
- Compared outcomes using multivariate logistic regression after propensity score matching.
Main Results:
- IVUS-guided PCI was associated with significantly lower in-hospital mortality (aOR 0.736, p=0.013).
- Higher utilization of mechanical circulatory support was observed in the IVUS-guided group (aOR 2.138, p<0.001).
- No significant differences were found in cardiogenic shock or procedural complication rates between groups.
Conclusions:
- IVUS-guided PCI in NSTEMI patients is linked to reduced in-hospital mortality.
- Increased need for mechanical circulatory support accompanies IVUS-guided PCI.
- Further large prospective trials are needed to confirm these findings.
Abstract:
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
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