Photo Credit: Pitchayanan Kongkaew

Intravascular ultrasound-guided percutaneous coronary intervention reduced target vessel failure in patients with acute coronary syndrome.

In patients with acute coronary syndrome (ACS), intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduced target vessel failure at 1 year compared with angiography-guided PCI in the IVUS-ACS trial. This benefit was driven by reductions in target vessel myocardial infarction and target vessel revascularization.

Until recently, only three small randomized-controlled trials of intravascular imaging-guided versus angiography-guided PCI have been performed in patients with ACS. Therefore, the aim of the IVUS-ACS trial (NCT03971500), presented by Shao-Liang Chen MD, PhD, MSCAI, from the Nanjing Medical University in China, was to investigate whether IVUS guidance compared with angiography guidance improves the outcomes of PCI in patients.

All participants presented with ACS within 30 days before randomization. The analysis included 3,505 participants from 58 centers in China (over 2,000 of the participants), Italy, Pakistan, and the UK, who were randomized to IVUS-guided PCI (n=1,753) or angiography-guided PCI (n=1,752). In the IVUS group, 39.9% had unstable angina, 32.5% had a non-ST elevation myocardial infarction (STEMI), and 27.6% had a STEMI. The percentages in the angiography-guided group were similar: 41.4% unstable angina, 30.7% non-STEMI, and 27.9% STEMI.

The primary study endpoint was vessel failure, a composite of cardiac death, target vessel MI, or clinically driven target vessel revascularization 1 year after randomization. At this time, 4.0% in the IVUS-guided PCI group compared with 7.3% of participants in the angiography-guided PCI group reached this endpoint, a highly significant difference (HR 0.55; 95% CI 0.41–0.74; P<0.01) driven by reductions in target vessel MI and target vessel revascularization. The safety outcomes were similar between the 2 groups.

Dr. Chen pointed out that all subgroups, including participants with diabetes, multivessel disease, or those receiving antiplatelet therapy, benefitted from the IVUS-guided stent implantation independent of whether they had unstable angina, a STEMI, or non-STEMI.

Medical writing support was provided by Dr. Susanne Kammerer
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