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Impact of intravascular ultrasound in acute myocardial infarction patients at high ischemic risk

 Ji Woong Roh  ;  SungA Bae  ;  Thomas W Johnson  ;  Yongcheol Kim  ;  Deok-Kyu Cho  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Myung Ho Jeong  ;  KAMIR-NIH investigators 
 REVISTA ESPANOLA DE CARDIOLOGIA, Vol.76(8) : 589-599, 2023-08 
Journal Title
Issue Date
Coronary Angiography / adverse effects ; Coronary Artery Disease* / etiology ; Drug-Eluting Stents* ; Humans ; Myocardial Infarction* / diagnosis ; Myocardial Infarction* / epidemiology ; Myocardial Infarction* / surgery ; Percutaneous Coronary Intervention* / methods ; Treatment Outcome ; Ultrasonography, Interventional / methods
Alto riesgo ; High-risk ; IVUS ; Infarto de miocardio ; Intervencionismo ; Interventional ; Intravascular ultrasound ; Myocardial infarction
Introduction and objectives: Evidence for the role of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients at high ischemic risk of acute myocardial infarction (AMI) is lacking. This study aimed to investigate the long-term clinical impact of IVUS-guided PCI in patients at high ischemic risk of AMI.

Methods: Among 13 104 patients with AMI enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we selected 8890 patients who underwent successful PCI with second-generation drug-eluting stent implantation and classified them into 2 groups based on whether or not they were at high ischemic risk or not, defined as any of the following: number of stents implanted ≥ 3, 3 vessels treated, ≥ 3 lesions treated, total stent length> 60mm, left main PCI, diabetes mellitus, and chronic kidney disease. The primary outcome was target lesion failure including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years.

Results: In 4070 AMI patients at high ischemic risk, IVUS-guided PCI (21.6%) was associated with a significantly lower risk of target lesion failure at 3 years (6.7% vs 12.0%; HR, 0.54; 95%CI, 0.41-0.72; P <.001) than angiography-guided PCI. The results were consistent after confounder adjustment, inversed probability weighting, and propensity score matching.

Conclusions: In patients at high ischemic risk of AMI who underwent PCI with second-generation drug-eluting stent implantation, use of IVUS guidance was associated with a significant reduction in 3-year target lesion failure. iCreaT study No. C110016.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Yongcheol(김용철) ORCID logo https://orcid.org/0000-0001-5568-4161
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Roh, Ji Woong(노지웅)
Bae, SungA(배성아) ORCID logo https://orcid.org/0000-0003-1484-4645
Cho, Deok Kyu(조덕규)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
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