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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA

Sang Yoon Lee1, Hyun Sung Joh2, Hyun Kuk Kim3

  • 1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Revista Espanola De Cardiologia (English Ed.)
|December 6, 2025
PubMed

Insights

Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) reduces major adverse cardiac events (MACE) in acute myocardial infarction (AMI) patients with complex (B2/C) lesions. This benefit was not observed in simpler (A/B1) lesions, suggesting increased value with lesion complexity.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Intravascular imaging (IVI) guidance improves percutaneous coronary intervention (PCI) outcomes for complex coronary lesions.
  • Its benefit in acute myocardial infarction (AMI) patients, stratified by ACC/AHA lesion classification, remains uncertain.

Purpose of the Study:

  • To evaluate the clinical benefit of IVI-guided PCI versus angiography-guided PCI in AMI patients with different ACC/AHA lesion complexities.
  • To determine if IVI guidance offers prognostic advantages based on infarct-related artery lesion characteristics.

Main Methods:

  • A pooled analysis of 2 Korean AMI registries (KAMIR-V, KAMIR-NIH) including 23,051 patients undergoing successful PCI.
  • Patients were stratified by ACC/AHA lesion classification (Type A/B1 vs. Type B2/C).
  • Comparison of 3-year major adverse cardiac events (MACE) between IVI-guided and angiography-guided PCI groups.

Main Results:

  • IVI-guided PCI showed a significantly lower incidence of MACE in patients with Type B2/C lesions (adjusted HR, 0.78; P < .001).
  • No significant difference in MACE was observed between IVI-guided and angiography-guided PCI for Type A/B1 lesions (adjusted HR, 0.81; P = .190).
  • This pattern held true for both non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction subgroups.

Conclusions:

  • IVI-guided PCI is associated with reduced MACE in AMI patients with complex (Type B2/C) coronary lesions.
  • The prognostic benefit of IVI-guided PCI is lesion complexity-dependent, increasing with greater complexity.
  • Angiography-guided PCI may suffice for simpler (Type A/B1) lesions in AMI patients.
Abstract

Keywords:
ACC/AHA lesion classificationAcute myocardial infarctionClasificación de lesiones ACC/AHA.Imágenes endovascularesInfarto agudo de miocardioIntervención coronaria percutáneaIntravascular imagingPercutaneous coronary intervention

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