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.
Abstract
Introduction and objectives: There are no clinical
data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided percutaneous coronary
intervention in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided percutaneous coronary intervention in patients with acute
myocardial infarction 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 acute myocardial infarction and cardiogenic shock who underwent percutaneous coronary intervention 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 percutaneous coronary intervention and 1458 patients (79.5%) underwent angiography-guided percutaneous
coronary intervention. Intravascular imaging-guided percutaneous coronary intervention was associated with a significantly lower risk of 1-year major adverse cardiovascular events than angiography-guided percutaneous coronary intervention (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 acute myocardial infarction patients
with cardiogenic shock, intravascular imaging-guided percutaneous coronary intervention was associated with a lower risk of major adverse cardiovascular events at 1-year than angiography-guided percutaneous coronary intervention, mainly driven by the lower risk of cardiac death.
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