The following is a summary of “Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis,” published in the August 2023 issue of the Cardiovascular Disease by Titus et al.
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is recommended for complex interventions. Evidence is scarce for outcomes, with extensive studies on utilizing intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) in cases of non-ST-elevation myocardial infarction (NSTEMI). The primary aim was to assess and contrast the in-hospital results of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with those of non-guided PCI in patients hospitalized for non-ST-segment elevation myocardial infarction (NSTEMI). The National Inpatient Sample (2016 to 2019) was examined to identify all hospitalizations with a primary diagnosis of non-ST segment elevation myocardial infarction (NSTEMI). Researchers compared outcomes between percutaneous coronary intervention (PCI) procedures with and without intravascular ultrasound (IVUS) guidance.
This comparison used a multivariate logistic regression model after performing propensity score matching. The primary focus of researcher’s study was to evaluate the occurrence of in-hospital mortality as the primary outcome. About 671,280 hospitalizations related to Non-ST Elevation Myocardial Infarction (NSTEMI) were identified. Among these, 48,285 individuals (7.2%) underwent Percutaneous Coronary Intervention (PCI) guided by Intravascular Ultrasound (IVUS), while 622,995 individuals (92.8%) underwent PCI without IVUS guidance. Following a thorough analysis of matched pairs, it was determined that intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) exhibited a reduced risk of mortality during the hospital stay compared to non-IVUS PCI (adjusted odds ratio [aOR] 0.736, CI 0.578 to 0.937, P = 0.013).
Nevertheless, mechanical circulatory support was increased in the intravascular ultrasound-guided percutaneous coronary intervention (adjusted odds ratio 2.138, CI 1.84 to 2.47, P <0.001) compared to non-intravascular ultrasound-guided percutaneous coronary intervention. The likelihood of experiencing cardiogenic shock (adjusted odds ratio [aOR] 1.11, CI 0.93 to 1.32, P = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, P = 0.22) were comparable among the study groups. Therefore, it is deduced that individuals diagnosed with non-ST segment elevation myocardial infarctions (NSTEMIs) who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) exhibited a reduced likelihood of mortality during their hospital stay and a higher need for mechanical circulatory support compared to those who underwent non-IVUS PCI. Notably, the two groups had no discernible disparities in procedural complications. Large prospective clinical trials are crucial to validate these findings.
Source: sciencedirect.com/science/article/abs/pii/S0002914923003089