Revista espanola de cardiologia (English ed.) · 2025
Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA lesion classification.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lee Sang Yoon, Joh Hyun Sung, Kim Hyun Kuk, Kim Ju Han, Hong Young Joon, Ahn Youngkeun, Jeong Myung Ho, Hur Seung Ho, Kim Doo-Il, Chang Kiyuk, Park Hun Sik, Bae Jang-Whan, Jeong Jin-Ok, Park Yong Hwan, Yun Kyeong-Ho, Yoon Chang-Hwan, Kim Yisik, Hwang Jin-Yong, Kim Hyo-Soo, Kwon Woochan, Shin Doosup, Choi Ki Hong, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Lee Seung Hun, Lee Joo Myung, KAMIR Investigators
Аннотация
INTRODUCTION AND OBJECTIVES: Despite the favorable prognosis associated with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) for complex coronary lesions, it is still unclear whether IVI-guided PCI for such lesions provides clinical benefit in patients with acute myocardial infarction (AMI) according to the ACC/AHA lesion classification.
METHODS: This study was a patient-level pooled analysis of 2 nationwide Korean AMI registries. We identified 23 051 patients from KAMIR-V and KAMIR-NIH who underwent successful PCI for an infarct-related artery and stratified them by the ACC/AHA lesion classification. Clinical outcomes were compared between IVI-guided and angiography-guided PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, AMI, repeat revascularization, and stent thrombosis, at 3 years.
RESULTS: IVI-guided PCI demonstrated a lower incidence of MACE compared with angiography-guided PCI in patients with type B2/C lesions (adjusted HR, 0.78; 95%CI, 0.70-0.88; P <.001), but not in patients with type A/B1 lesions (adjusted HR, 0.81, 95%CI, 0.60-1.11; P=.190). In both non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction, a significantly lower risk of MACE following IVI-guided PCI than angiography-guided PCI was observed in patients with type B2/C lesions (non-ST-segment elevation myocardial infarction: adjusted HR, 0.73; 95%CI, 0.63-0.84; P <.001; ST-segment elevation myocardial infarction: adjusted HR, 0.86, 95%CI, 0.75-0.98; P=.027), but not in those with type A/B1 lesions.
CONCLUSIONS: Among patients with AMI, IVI-guided PCI was associated with a significantly lower risk of MACE in those with type B2/C lesions, but not in those with type A/B1 lesions. The prognostic benefit of IVI-guided PCI increased with greater lesion complexity in the infarct-related artery.
METHODS: This study was a patient-level pooled analysis of 2 nationwide Korean AMI registries. We identified 23 051 patients from KAMIR-V and KAMIR-NIH who underwent successful PCI for an infarct-related artery and stratified them by the ACC/AHA lesion classification. Clinical outcomes were compared between IVI-guided and angiography-guided PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, AMI, repeat revascularization, and stent thrombosis, at 3 years.
RESULTS: IVI-guided PCI demonstrated a lower incidence of MACE compared with angiography-guided PCI in patients with type B2/C lesions (adjusted HR, 0.78; 95%CI, 0.70-0.88; P <.001), but not in patients with type A/B1 lesions (adjusted HR, 0.81, 95%CI, 0.60-1.11; P=.190). In both non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction, a significantly lower risk of MACE following IVI-guided PCI than angiography-guided PCI was observed in patients with type B2/C lesions (non-ST-segment elevation myocardial infarction: adjusted HR, 0.73; 95%CI, 0.63-0.84; P <.001; ST-segment elevation myocardial infarction: adjusted HR, 0.86, 95%CI, 0.75-0.98; P=.027), but not in those with type A/B1 lesions.
CONCLUSIONS: Among patients with AMI, IVI-guided PCI was associated with a significantly lower risk of MACE in those with type B2/C lesions, but not in those with type A/B1 lesions. The prognostic benefit of IVI-guided PCI increased with greater lesion complexity in the infarct-related artery.