Intravascular modality-guided versus angiography-guided percutaneous coronary intervention in acute myocardial infarction
- Namkyun Kim; Jang Hoon Lee; Se Yong Jang; Myung Hwan Bae; Dong Heon Yang; Hun Sik Park; Yongkeun Cho; Myung Ho Jeong; Jong-Seon Park; Hyo-Soo Kim; Seung-Ho Hur; In-Whan Seong; Myeong-Chan Cho; Chong-Jin Kim; Shung Chull Chae
- Dept. of Internal Medicine (내과학)
- Issue Date
- Catheterization and Cardiovascular Interventions, Vol.() : -, 2019
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.
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.
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).
In this large-scale AMI registry, intravascular modality guidance was associated with an improving clinical outcome in selected high-risk patients.
- acute myocardial infarction; angiography; fractional flow reserve; intravascular ultrasound; optical coherence tomography; prognosis
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- 1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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