Long-Term Clinical Outcomes of Acute Myocardial Infarction Based on Institutional Experience With IVUS

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention improves patient outcomes, yet the impact of a center's IVUS experience on long-term outcomes remains unclear. We evaluated whether the prognostic association of IVUS-guided percutaneous coronary intervention in patients with acute myocardial infarction differs based on a center's level of IVUS use.

We retrospectively analyzed 9752 patients with acute myocardial infarction treated with second-generation drug-eluting stents from the KAMIR-NIH (Korean Acute Myocardial Infarction Registry-National Institutes of Health). The primary outcome was 3-year major adverse cardiovascular events, defined as a composite of all-cause death, myocardial infarction, and coronary revascularization. The secondary outcome was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target lesion revascularization. Centers were classified into higher- or lower-IVUS-use groups on the basis of median institutional usage (10.3%).

In higher-use centers, IVUS-guided percutaneous coronary intervention was associated with lower rates of major adverse cardiovascular events (15.3% versus 18.5%, P=0.016) and target-lesion failure (6.3% versus 8.3%, P=0.039) in propensity score-matched populations. Multivariate Cox analysis confirmed lower risks of major adverse cardiovascular events (hazard ratio [HR], 0.80 [95% CI, 0.69-0.93]; P=0.003) and target-lesion failure (HR, 0.75 [95% CI, 0.59-0.93]; P=0.01). Conversely, in lower-use centers, IVUS guidance was not associated with significant differences in major adverse cardiovascular events (15.7% versus 18.6%, P=0.422) or target-lesion failure (8.9% versus 10.4%, P=0.644).

The association of IVUS-guided percutaneous coronary intervention with lower adverse event rates was more apparent and statistically demonstrable in centers with higher IVUS use. These findings suggest that institutional experience may amplify the observable impact of IVUS guidance, underscoring the potential value of standardized IVUS implementation in acute myocardial infarction management.