IVUS in Acute Coronary Syndrome: A New Requirement?

The use of intravascular ultrasound (IVUS) has seen exponential growth across registries over the years, combined with mounting and increasingly robust evidence. The fact that it will enable us to characterize plaque morphology and extension prior the intervention, and even assess stent expansion post intervention, has turned it into a pillar of our efforts to improve complicated outcomes, outweighing angiography guided PCI in multiple randomized studies. 

El uso del ultrasonido intravascular en la angioplastia de tronco no protegido se asocia con mejores resultados en comparación con la angioplastia guiada solo por angiografía.

However, in the clinical context of acute coronary syndrome (ACS) no evidence is yet strong enough for us to claim it is essential. 

Even though in most ACS patients we will normally be able to identify the culprit lesion and perform an angioplasty, a not insignificant percentage of patients will raise questions, such as those presenting clinical heterogeneity, with no changes in ECG and even an absence of segmentary alterations in the echocardiogram. In these cases, a 30% might lack a culprit lesion and around 10% will present multiple lesions potentially culprit. Which is why an imaging diagnostic tool such as IVUS might be able to answer these questions

In this observational study recently published in AHA, researchers set to find out whether the use of IVUS has any clinical impact in the treatment of ACS in the long term. 

Read also: IVUS vs iFR for Left Main Decision Making.

They analyzed ACS patients without ST elevation MI, intervened with second generation stents, from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) followed up at 3 years, between 2011 and 2015. Primary end point was target lesion failure (TLF) at 3 years, which is a combination of cardiac death, myocardial infarction, and ischemia driven revascularization of culprit lesion.  

Of the overall studied population (n=9007), 7120 patients received a second-generation stent guided by angiography, and in 1887 patients the intervention was guided by IVUS. 

Researchers observed the risk of TLF at 3 years was significantly lower in the IVUS group vs. the angiography guided group (HR, 0.59, 0.47-0.73, p<0.001), mainly at the expense of cardiac mortality and target vessel myocardial infarction. 

Read also: IVUS vs OCT to Guide PCI: Which Should We Choose?

Such a drop in primary end point maintained across multiple sensitivity analysis and across different pre-specified subgroups. The same happened with secondary end points of cardiac mortality (HR=0.56, 0.42-0.73 p<0.001) and MACE (HR=0.76, 0.66-0.87, p<0.001).

Authors’ Conclusions

With the limitations of a randomized study, sensitivity and propensity analysis were carried out, resulting in significantly reduced TLF at 3 years, at the expense of hard end points such as morality and target vessel myocardial infarction. These outcomes suggest an important role of IVUS in the treatment of acute coronary syndrome.  

Dr. Omar Tupayachi

Dr. Omar Tupayachi.
Membro do Conselho Editorial da SOLACI.org

Original Title: Role of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Optimizing Outcomes in Acute Myocardial Infarction.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....