Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction in the United States

Chayakrit Krittanawong; Song Peng Ang; Neil Sagar Maitra; Zhen Wang; Mahboob Alam; Hani Jneid; Samin Sharma

doi:10.1002/ccd.31389

Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction in the United States

Catheter Cardiovasc Interv. 2024 Dec 31. doi: 10.1002/ccd.31389. Online ahead of print.

Authors

Chayakrit Krittanawong¹, Song Peng Ang², Neil Sagar Maitra³, Zhen Wang^{4

5}, Mahboob Alam⁶, Hani Jneid⁷, Samin Sharma⁸

Affiliations

¹ Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, New York, USA.
² Division of Internal Medicine, Rutgers Health/Community Medical Center, New Jersey, USA.
³ Division of Cardiology, Scripps Clinic, La Jolla, California, USA.
⁴ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
⁶ The Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
⁷ John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston, Texas, USA.
⁸ Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA.

PMID: 39737533
DOI: 10.1002/ccd.31389

Abstract

Background: The role of Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is still unclear in patients with STEMI undergoing PCI in the current second-generation DES era.

Aims: This study aimed to evaluate the trends and outcomes of IVUS-guided PCI in patients with STEMI.

Methods: We used the National Inpatient Sample (NIS) database from 2016 to 2021. The primary endpoint of this study is all-cause in-hospital mortality. Secondary endpoints include trends of PCI hospitalizations, trends of mortality, length of stay, and cost of hospitalization.

Results: There were data for 819,645 hospitalizations for STEMI, of which 91.2% (n = 74,7860) utilized angiography-guided PCI, 8.4% (n = 68,985) utilized IVUS-guided PCI and 0.3% (n = 2800) utilized OCT-guided PCI. In-hospital mortality for IVUS-guided PCI was 4.6% (n = 3190) versus 6.0% (n = 44,935) for angiography-guided PCI with an adjusted OR 0.75 (0.68-0.81, p < 0.001). In-hospital mortality for OCT-guided PCI was 3.4% (n = 95) versus 6.0% (n = 44,935) for angiography-guided PCI with an adjusted OR 0.67 (0.43-1.06, p = 0.09).

Conclusions: IVUS/OCT-guidance was increasingly utilized over the years and was associated with a significantly reduced adjusted odds of in-hospital mortality. Large-scale, long-term randomized data are needed to better ascertain where IVUS/OCT may be best utilized for optimization of PCI for STEMI.