Efficacy of intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Background The intravascular ultrasound(IVUS)-guided percutaneous coronary intervention(PCI) can benefit the treatment of coronary artery disease(CAD). However, the beneficial effect of IVUS-guided PCI in patients with acute myocardial infarction(AMI) remains controversial. Methods A total of 537 AMI patients were included in this study, divided into two groups: the angiography-guided group(n=289) and the IVUS-guided group(n=248) according to whether the IVUS was applied. The primary outcome was a composite of major adverse cardiovascular events(MACEs), including cardiovascular death, recurrent myocardial infarction(MI), and target lesion revascularization(TLR). The secondary outcome was procedural radiation exposure time. Results The IVUS-guided group was associated with a reduced incidence of MACEs(12.8% vs. 8.5%, P=0.032). The results were consistent after adjusting for confounders in the multivariable Cox analysis, which showed that the absence of IVUS(HR 1.194, 95% CI 1.061-1.323, P=0.011) was an independent predictor of MACEs. Additionally, the IVUS-guided group experienced significantly lower float time(893.3±265.2 min vs. 623.2±137.3 min, P<0.001). Conclusions The use of IVUS was associated with better long-term cardiovascular outcomes. The use of IVUS in PCI should be considered for patients with AMI to optimize procedural outcomes and enhance long-term prognosis. [S Chin J Cardiol 2024; 25(2): 109-116]