Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock

Rev Esp Cardiol (Engl Ed). 2024 Dec;77(12):995-1007. doi: 10.1016/j.rec.2024.03.009. Epub 2024 Apr 10.
[Article in English, Spanish]

Abstract

Introduction and objectives: There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

Methods: Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis.

Results: Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P<.001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P<.001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88).

Conclusions: In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.

Keywords: Acute myocardial infarction; Cardiogenic shock; Imagen intravascular; Infarto agudo de miocardio; Intervención coronaria percutánea; Intravascular imaging; Percutaneous coronary intervention; Shock cardiogénico.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Coronary Angiography* / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / epidemiology
  • Percutaneous Coronary Intervention* / methods
  • Registries*
  • Retrospective Studies
  • Shock, Cardiogenic* / etiology
  • Treatment Outcome
  • Ultrasonography, Interventional / methods