title: Intravascular Ultrasound Guidance vs. Angiographic Guidance in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction - Long-Term Clinical Outcomes From the CREDO-Kyoto AMI Registry.
abstract: BACKGROUND
  In the setting of elective percutaneous coronary intervention (PCI), intravascular ultrasound (IVUS)-guided PCI is associated with a reduction in the incidence of target vessel revascularization (TVR), but the impact of IVUS on long-term clinical outcome in the setting of emergency PCI for ST-segment elevation acute myocardial infarction (STEMI) is still unclear.
  
  
  RESULTS
  The subjects consisted of 3,028 STEMI patients who underwent primary PCI within 24 h of symptom onset in the CREDO-Kyoto acute myocardial infarction registry. Of these, 932 patients (31%) underwent IVUS-guided PCI. Compared with the angiography-guided PCI without IVUS, IVUS-guided PCI was associated with significantly lower incidences of TVR (primary outcome measure; 22% vs. 27%, log-rank P<0.001) and definite stent thrombosis (ST; 1.2% vs. 3.1%, log-rank P=0.003). The cumulative incidence of all-cause death was not significantly different between the 2 groups. After adjusting for confounders, however, there were no significant differences between the 2 groups in risk for TVR (adjusted HR, 1.14; 95% CI: 0.86-1.51, P=0.38) and definite ST (adjusted HR, 0.58; 95% CI: 0.19-1.72, P=0.33).
  
  
  CONCLUSIONS
  IVUS-guided PCI was not associated with a lower risk for TVR or ST in STEMI patients undergoing primary PCI.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakatsuma
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Hiroki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D012042:Registries; D018084:Ultrasonography, Interventional