Multimodality Intravascular Imaging Guidance (NIRS-IVUS-OCT) Compared to Angiography-Guided Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: The NIRVUS Trial.

BACKGROUND

Imaging-guided percutaneous coronary intervention (PCI) improves outcomes, but the clinical utility of near-infrared spectroscopy (NIRS) remains unclear.

AIMS: The aim of the study was to evaluate whether multimodality imaging with NIRS, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) would improve stent strut coverage compared with angiography-guided PCI in patients with acute myocardial infarction (MI) and further to assess the impact of lipid-rich plaque (LRP) on vascular healing.

METHODS

A total of 104 patients with MI were randomized to imaging- or angiography-guided PCI. NIRS-IVUS imaging was performed pre- and post-PCI, and OCT post-PCI and at 6-month follow-up. Maximum lipid core burden index in a 4-mm segment (maxLCBI4 mm) was measured. The primary endpoint was percentage of covered stent struts (OCT) at 6-month follow-up.

RESULTS

Pre-PCI maxLCBI4 mm was similar in the two groups (441 [239, 565] vs. 333 [242, 517], p = 0.19). Imaging guidance resulted in a larger minimal stent area (7.3 ± 2.4 mm2 vs. 6.5 ± 1.7 mm2, p = 0.04). At 6-month follow-up, stent strut coverage was higher in the imaging group (86.9% [77.7, 93.7] vs. 74.4% [53.8, 81.8], p < 0.001). Segment-level analyses showed that LRP without superficial attenuation and suboptimal stent expansion was associated with higher percentage of intima hyperplasia (23.4% [20.5, 25.9] vs. 13.9% [10.6, 16.0], p < 0.001) compared to optimal stent expansion, whereas LRP with attenuation and suboptimal stent expansion was associated with higher rates of late-acquired stent malapposition (81.8% vs. 30.0%, p = 0.02) compared to optimal stent expansion.

CONCLUSION

Imaging-guided PCI improved stent strut coverage. LRP phenotypes were associated with different healing patterns.

CLINICAL TRIAL REGISTRATION INFORMATION: Clinical Trial Registration Information: URL: https://www.

CLINICALTRIALS: gov; Unique identifier: NCT04460482.