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Original article
Available online 26 April 2024
Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock
Intervención coronaria percutánea guiada por imagen intravascular en pacientes con infarto agudo de miocardio y shock cardiogénico
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Hyun Sung Joha, Seung Hun Leeb, Jinhwan Joc, Hyun Kuk Kimd, Woo-Hyun Lima, Hack-Lyoung Kima, Jae-Bin Seoa, Woo-Young Chunga, Sang-Hyun Kima, Joo-Hee Zoa, Myung-A. Kima, Min Chul Kimb, Ju Han Kimb, Young Joon Hongb, Young Keun Ahnb, Myung Ho Jeongb, Seung Ho Hure, Doo Il Kimf, Kiyuk Changg, Hun Sik Parkh..., Jang-Whan Baei, Jin-Ok Jeongj, Yong Hwan Parkk, Kyeong Ho Yunl, Chang-Hwan Yoonm, Yisik Kimn, Jin-Yong Hwango, Hyo-Soo Kimp, David Hongc, Woochan Kwonc, Ki Hong Choic, Taek Kyu Parkc, Jeong Hoon Yangc, Young Bin Songc, Joo-Yong Hahnc, Seung-Hyuk Choic, Hyeon-Cheol Gwonc, Joo Myung Leec,
Corresponding author
,
the KAMIR Investigators Ver más
a Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
b Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
c Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
d Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
e Department of Internal Medicine and Cardiovascular Center, Keimyung University Dongsan Medical Center, Daegu, Korea
f Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea
g Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
h Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
i Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
j Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
k Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
l Department of Internal Medicine and Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea
m Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
n Department of Internal Medicine and Cardiovascular Center, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
o Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
p Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Tables (5)
Table 1. Comparison of baseline characteristics according to treatment strategy
Table 2. Comparison of lesion and procedural characteristics according to treatment strategy
Table 3. Comparison of in-hospital mortality according to treatment strategy
Table 4. Comparison of clinical outcomes at 1-year according to treatment strategy
Table 5. Independent predictors for 1-year MACE
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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
Intravascular imaging
Percutaneous coronary intervention
Abbreviations:
95%CI
AMI
HR
MACE
OCT
PCI
Resumen
Introducción y objetivos

No existen datos clínicos sobre la eficacia de la intervención coronaria percutánea (ICP) guiada por imagen intravascular en comparación con la ICP guiada por angiografía en pacientes con infarto agudo de miocardio (IAM) y shock cardiogénico. El objetivo del presente estudio es evaluar el impacto de la ICP guiada por imagen intravascular en pacientes con IAM y shock cardiogénico.

Métodos

De un total de 28.732 pacientes del registro agrupado nacional de KAMIR-NIH (de noviembre de 2011 a diciembre de 2015) y KAMIR-V (de enero de 2016 a junio de 2020), se seleccionó en total a 1.833 pacientes (6,4%) con IAM y shock cardiogénico sometidos a ICP del vaso culpable. El objetivo primario del estudio fueron los eventos adversos cardiovasculares mayores (MACE) a 1 año, un compuesto de muerte cardiaca, infarto de miocardio, nueva revascularización y trombosis del stent definitiva o probable.

Resultados

De la población del estudio, 375 pacientes (20,5%) se sometieron a ICP guiada por imagen intravascular y 1.458 (79,5%), a ICP guiada por angiografía. La ICP guiada por imagen intravascular mostró un riesgo de MACE a 1 año significativamente menor que con la ICP guiada por angiografía (el 19,5 frente al 28,2%; HR=0,59; IC95%, 0,45-0,77; p<0,001), principalmente por un menor riesgo de muerte cardiaca (el 13,7 frente al 24,0%; HR=0,53; IC95%, 0,39-0,72; p<0,001). Estos resultados se mantuvieron tras el emparejamiento por puntuación de propensión (HR=0,68; IC95%, 0,46-0,99), la ponderación de probabilidad inversa (HR=0,61; IC95%, 0,45-0,83) y el análisis bayesiano (OR=0,66; IC95%, 0,49-0,88).

Conclusiones

En los pacientes con IAM y shock cardiogénico, la ICP guiada por imagen intravascular se asoció con un riesgo de MACE a 1 año menor que con la ICP guiada por angiografía, sobre todo por el menor riesgo de muerte cardiaca.

Palabras clave:
Infarto agudo de miocardio
Shock cardiogénico
Imagen intravascular
Intervención coronaria percutánea

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