TY - JOUR
T1 - Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis
AU - Titus, Anoop
AU - Majmundar, Vidit
AU - Taha, Amro
AU - Patel, Nirav
AU - Sooraj, Mannil
AU - Omkumar, Janaki M.
AU - Koshy, Rohan Mathews
AU - Saji, Anu Mariam
AU - Sherif, Akil Adrian
AU - Titus, Aishwarya
AU - Kadavath, Sabeeda
AU - Vallabhajosyula, Saraschandra
AU - Nasir, Khurram
AU - Dani, Sourabh S.
N1 - Copyright © 2023 Elsevier Inc. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non–ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (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 similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
AB - Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non–ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (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 similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
KW - Humans
KW - Percutaneous Coronary Intervention
KW - Non-ST Elevated Myocardial Infarction
KW - Prospective Studies
KW - Treatment Outcome
KW - Ultrasonography, Interventional
KW - Regression Analysis
KW - Coronary Angiography
KW - Coronary Artery Disease
UR - http://www.scopus.com/inward/record.url?scp=85163102352&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85163102352&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2023.05.022
DO - 10.1016/j.amjcard.2023.05.022
M3 - Article
C2 - 37307785
AN - SCOPUS:85163102352
SN - 0002-9149
VL - 200
SP - 95
EP - 102
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -