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

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is known to improve patient outcomes.
• However, the impact of a medical center's cumulative experience with IVUS on long-term results after PCI for acute myocardial infarction (AMI) is not well understood.

Purpose of the Study:

• To investigate whether the prognostic value of IVUS-guided PCI in AMI patients varies depending on the center's level of IVUS utilization.
• To determine if higher institutional IVUS experience amplifies the observed benefits of IVUS guidance.

Main Methods:

• Retrospective analysis of 9752 patients with AMI treated with second-generation drug-eluting stents from the KAMIR-NIH registry.
• Centers were categorized into higher- or lower-IVUS-use groups based on the median institutional usage rate (10.3%).
• Primary outcome: 3-year major adverse cardiovascular events (MACE); Secondary outcome: target-lesion failure (TLF). Propensity score matching and multivariate Cox analysis were employed.

Main Results:

• In higher-IVUS-use centers, IVUS-guided PCI was associated with significantly lower rates of MACE (15.3% vs. 18.5%, P=0.016) and TLF (6.3% vs. 8.3%, P=0.039) post-propensity score matching.
• Multivariate analysis confirmed reduced risks for MACE (HR, 0.80; P=0.003) and TLF (HR, 0.75; P=0.01) in higher-use centers.
• Conversely, IVUS guidance showed no significant association with MACE or TLF in lower-IVUS-use centers.

Conclusions:

• The beneficial association between IVUS-guided PCI and reduced adverse events is more pronounced and statistically significant in centers with higher IVUS utilization.
• Institutional experience with IVUS appears to amplify its clinical impact.
• Findings support the potential value of standardized IVUS implementation in the management of acute myocardial infarction.