title: Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention.
abstract: Stent thrombosis and restenosis remain drawbacks of drug-eluting stents in patients with acute myocardial infarction (AMI). Intravascular ultrasound (IVUS) guidance for stent deployment helps optimize its results in stable patients. The aim of this study was to examine the utility of routine IVUS guidance in patients with AMI undergoing percutaneous coronary intervention (PCI). Employing data from Korea Acute Myocardial Infarction Registry (KAMIR), we analyzed 14,329 patients with AMI from April 2006 through September 2010. Patients with cardiogenic shock and rescue PCI after thrombolysis were excluded. Clinical outcomes of 2,127 patients who underwent IVUS-guided PCI were compared to those of 8,235 patients who did not. Mean age was 63.6 ± 13.5 years and 72.3% were men. Patients undergoing IVUS-guided PCI were younger, more often men, more hyperlipemic, and had increased body mass index and left ventricular ejection fraction. Number of treated vessels and stents used, stent length, and stent diameter were increased in the IVUS-guided group. Multivessel involvement was less frequent and American College of Cardiology/American Heart Association type C lesion was more frequent in the IVUS-guided group. Drug-eluting stents were more frequently used compared to bare-metal stents in the IVUS group. There was no significant relation of stent thrombosis between the 2 groups. Twelve-month all-cause death was lower in the IVUS group. After multivariate analysis and propensity score adjustment, IVUS guidance was not an independent predictor for 12-month all-cause death (hazard ratio 0.212, 0.026 to 1.73, p = 0.148). In conclusion, this study does not support routine use of IVUS guidance for stent deployment in patients who present with AMI and undergo PCI.
authors.affiliation: The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Khurshid
authors.initials: K
authors.lastname: Ahmed
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Rabin
authors.initials: R
authors.lastname: Chakraborty
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.forename: Keunho
authors.initials: K
authors.lastname: Park
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Kyung Hoon
authors.initials: KH
authors.lastname: Cho
authors.forename: Min Chol
authors.initials: MC
authors.lastname: Kim
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hachinohe
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Hwang
authors.forename: Min Goo
authors.initials: MG
authors.lastname: Lee
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D018084:Ultrasonography, Interventional / Q000379:methods*