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Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and

Hyun Sung Joh1, Seung Hun Lee2, Jinhwan Jo3

  • 1Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

Revista Espanola De Cardiologia (English Ed.)
|April 12, 2024
PubMed

Insights

Intravascular imaging-guided percutaneous coronary intervention (PCI) significantly reduces major adverse cardiovascular events (MACE) in acute myocardial infarction (AMI) patients with cardiogenic shock. This approach lowers cardiac death risk compared to traditional angiography-guided PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Limited clinical data exist on intravascular imaging-guided percutaneous coronary intervention (PCI) versus angiography-guided PCI in acute myocardial infarction (AMI) with cardiogenic shock.
  • Evaluating this comparison is crucial for optimizing treatment strategies in high-risk cardiac patients.

Purpose of the Study:

  • To assess the impact of intravascular imaging-guided PCI on clinical outcomes in patients experiencing AMI complicated by cardiogenic shock.
  • To compare the efficacy of intravascular imaging versus angiography guidance for PCI in this specific patient cohort.

Main Methods:

  • A retrospective analysis of 1833 patients with AMI and cardiogenic shock who underwent PCI from a nationwide pooled registry (KAMIR-NIH and KAMIR-V).
  • Patients were divided into intravascular imaging-guided PCI (n=375) and angiography-guided PCI (n=1458) groups.
  • The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, including cardiac death, myocardial infarction, repeat revascularization, and stent thrombosis. Propensity score matching, inverse probability weighting, and Bayesian analysis were used for adjustment.

Main Results:

  • Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE compared to angiography-guided PCI (19.5% vs 28.2%; HR, 0.59).
  • This reduction was primarily driven by a significantly lower risk of cardiac death in the imaging-guided group (13.7% vs 24.0%; adjusted HR, 0.53).
  • Results remained consistent across various statistical adjustment methods, including propensity score matching and inverse probability weighting.

Conclusions:

  • Intravascular imaging-guided PCI demonstrates a superior safety profile in patients with AMI and cardiogenic shock compared to angiography-guided PCI.
  • The improved outcomes are mainly attributed to a reduction in cardiac mortality, highlighting the benefit of enhanced visualization during PCI in complex cases.
Abstract

Keywords:
Acute myocardial infarctionCardiogenic shockImagen intravascularInfarto agudo de miocardioIntervención coronaria percutáneaIntravascular imagingPercutaneous coronary interventionShock cardiogénico

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