Premium
Intravascular modality‐guided versus angiography‐guided percutaneous coronary intervention in acute myocardial infarction
Author(s) -
Kim Namkyun,
Lee Jang Hoon,
Jang Se Yong,
Bae Myung Hwan,
Yang Dong Heon,
Park Hun Sik,
Cho Yongkeun,
Jeong Myung Ho,
Park JongSeon,
Kim HyoSoo,
Hur SeungHo,
Seong InWhan,
Cho MyeongChan,
Kim ChongJin,
Chae Shung Chull
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28359
Subject(s) - medicine , intravascular ultrasound , percutaneous coronary intervention , myocardial infarction , fractional flow reserve , conventional pci , hazard ratio , revascularization , cardiology , clinical endpoint , timi , angiography , radiology , confidence interval , coronary angiography , randomized controlled trial
Background Few data are available for current usage patterns of intravascular modalities such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) in acute myocardial infarction (AMI). Moreover, patient and procedural‐based outcomes related to intravascular modality guidance compared to angiography guidance have not been fully investigated yet. Methods We examined 11,731 patients who underwent percutaneous coronary intervention (PCI) from the Korea AMI Registry–National Institute of Health database. Patient‐oriented composite endpoint (POCE) was defined as all‐cause death, any infarction, and any revascularization. Device‐oriented composite endpoint (DOCE) was defined as cardiac death, target‐vessel reinfarction, and target‐lesion revascularization. Results Overall, intravascular modalities were utilized in 2,659 (22.7%) patients including 2,333 (19.9%) IVUS, 277 (2.4%) OCT, and 157 (1.3%) FFR. In the unmatched cohort, POCE (5.4 vs. 8.5%; adjusted hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.61–0.93; p = .008) and DOCE (4.6 vs. 7.4%; adjusted HR 0.77; 95% CI 0.61–0.97; p = .028) were significantly lower in intravascular modality‐guided PCI compared with angiography‐guided PCI. In the propensity‐score‐matched cohorts, POCE (5.9 vs. 7.7%; HR 0.74; 95% CI 0.60–0.92; p = .006) and DOCE (5.0 vs. 6.8%; HR 0.72; 95% CI 0.57–0.90; p = .004) were significantly lower in intravascular modality guidance compared with angiography guidance. The difference was mainly driven by reduced all‐cause mortality (4.4 vs. 7.0%; p < .001) and cardiac mortality (3.3 vs. 5.2%; p < .001). Conclusion In this large‐scale AMI registry, intravascular modality guidance was associated with an improving clinical outcome in selected high‐risk patients.