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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
3.2K
Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention for acute myocardial
Oh-Hyun Lee1, Seok-Jae Heo2, Thomas W Johnson3
1Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, 363 Dongbaekjukjeon-Daero, Giheung-Gu, Yongin, 16995, Republic of Korea.
Scientific Reports
|May 1, 2024
Summary
Intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) did not improve 1-year outcomes for patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) compared to angiography guidance. Target lesion failure rates were similar between the groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high mortality.
- Percutaneous coronary intervention (PCI) is the primary treatment for AMI, but optimal guidance in CS remains debated.
- Intravascular ultrasonography (IVUS) may offer superior visualization compared to angiography during PCI.
Purpose of the Study:
- To evaluate the impact of IVUS-guided PCI versus angiography-guided PCI on clinical outcomes in patients with AMI and CS.
- To assess the 1-year rate of target lesion failure (TLF) as the primary endpoint.
Main Methods:
- Retrospective analysis of pooled data from Korean AMI registries (2011-2020).
- Inclusion of 1418 patients with AMI and CS undergoing PCI with second-generation drug-eluting stents (DES).
- Comparison of IVUS-guided (n=294) versus angiography-guided (n=1124) PCI using inverse probability of treatment weighting (IPTW) and landmark analyses.
Main Results:
- The 1-year rate of target lesion failure (TLF) was not significantly different between IVUS-guided and angiography-guided PCI groups after IPTW analysis (HR 0.93; 95% CI 0.65-1.34).
- Adjusted landmark analyses at 30 days and between 30 days and 1 year also showed no significant differences in TLF between the groups.
- Both IVUS-guided and angiography-guided PCI utilized second-generation DES implantation.
Conclusions:
- In patients with AMI and CS treated with second-generation DES, IVUS-guided PCI does not appear to offer a significant benefit in reducing 1-year TLF compared to standard angiography-guided PCI.
- Further prospective studies may be warranted to definitively establish the role of IVUS in this high-risk patient population.
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