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The Clinical Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Acute Myocardial Infarction

Jinhwan Jo1, Hyun Sung Joh2, Hyun Kuk Kim3

  • 1Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.

The American Journal of Cardiology
|September 4, 2025
PubMed

Insights

Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) significantly reduces major adverse cardiovascular events and cardiac death in acute myocardial infarction (AMI) patients with high thrombus burden compared to angiography guidance.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Percutaneous coronary intervention (PCI) guided by intravascular imaging (IVI) demonstrates superior outcomes compared to angiography alone.
  • Limited evidence exists on the prognostic benefits of IVI-guided PCI specifically in acute myocardial infarction (AMI) patients with high thrombus burden.

Purpose of the Study:

  • To evaluate the prognostic impact of IVI-guided PCI versus angiography-guided PCI in patients with AMI and high thrombus burden.
  • To assess the effect on major adverse cardiovascular events (MACE), cardiac death, and stroke at 3-year follow-up.

Main Methods:

  • Retrospective analysis of nationwide registries (KAMIR-NIH and KAMIR-V) including 4,074 AMI patients with TIMI thrombus grades 4 or 5 who underwent aspiration thrombectomy.
  • Comparison of outcomes between 892 patients receiving IVI-guided PCI and 3,182 patients receiving angiography-guided PCI.
  • Primary outcome: MACE (all-cause death, MI, repeat revascularization, stent thrombosis). Secondary outcomes: cardiac death and stroke.

Main Results:

  • IVI-guided PCI was associated with a significantly lower risk of MACE (12.9% vs. 16.3%; adjusted HR, 0.80; P=0.035) and cardiac death (3.8% vs. 7.0%; adjusted HR, 0.65; P=0.025) at 3 years.
  • The reduction in MACE was primarily driven by a lower risk of all-cause death (5.7% vs. 10.0%; adjusted HR, 0.65; P=0.007).
  • No significant difference in stroke risk was observed between the groups.

Conclusions:

  • IVI-guided PCI demonstrates a favorable prognostic impact in AMI patients with high thrombus burden.
  • This approach is associated with reduced MACE and cardiac death compared to traditional angiography guidance.
  • Further hypothesis-generating studies support IVI guidance for improved outcomes in this high-risk patient population.

Keywords:
acute myocardial infarctionhigh thrombus burdenintravascular imagingmajor adverse cardiovascular eventspercutaneous coronary intervention

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