ISSN: 1885-5857 Impact factor 2023 7.2
Vol. 77. Num. 12.
Pages 995-1007 (December 2024)

Original article
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

Hyun Sung JohaSeung Hun LeebJinhwan JocHyun Kuk KimdWoo-Hyun LimaHack-Lyoung KimaJae-Bin SeoaWoo-Young ChungaSang-Hyun KimaJoo-Hee ZoaMyung-A. KimaMin Chul KimbJu Han KimbYoung Joon HongbYoung Keun AhnbMyung Ho JeongbSeung Ho HureDoo Il KimfKiyuk ChanggHun Sik ParkhJang-Whan BaeiJin-Ok JeongjYong Hwan ParkkKyeong Ho YunlChang-Hwan YoonmYisik KimnJin-Yong HwangoHyo-Soo KimpDavid HongcWoochan KwoncKi Hong ChoicTaek Kyu ParkcJeong Hoon YangcYoung Bin SongcJoo-Yong HahncSeung-Hyuk ChoicHyeon-Cheol GwoncJoo Myung Leec the KAMIR Investigators
Imagen extra
Rev Esp Cardiol. 2024;77:995-1007
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

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