Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock

Hyun Sung Joh; Seung Hun Lee; Jinhwan Jo; Hyun Kuk Kim; Woo-Hyun Lim; Hack-Lyoung Kim; Jae-Bin Seo; Woo-Young Chung; Sang-Hyun Kim; Joo-Hee Zo; Myung-A Kim; Min Chul Kim; Ju Han Kim; Young Joon Hong; Young Keun Ahn; Myung Ho Jeong; Seung Ho Hur; Doo Il Kim; Kiyuk Chang; Hun Sik Park; Jang-Whan Bae; Jin-Ok Jeong; Yong Hwan Park; Kyeong Ho Yun; Chang-Hwan Yoon; Yisik Kim; Jin-Yong Hwang; Hyo-Soo Kim; David Hong; Woochan Kwon; Ki Hong Choi; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Joo Myung Lee; KAMIR Investigators

doi:10.1016/j.rec.2024.03.009

Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock

Rev Esp Cardiol (Engl Ed). 2024 Apr 10:S1885-5857(24)00125-7. doi: 10.1016/j.rec.2024.03.009. Online ahead of print.

[Article in English, Spanish]

Authors

Hyun Sung Joh¹, Seung Hun Lee², Jinhwan Jo³, Hyun Kuk Kim⁴, Woo-Hyun Lim¹, Hack-Lyoung Kim¹, Jae-Bin Seo¹, Woo-Young Chung¹, Sang-Hyun Kim¹, Joo-Hee Zo¹, Myung-A Kim¹, Min Chul Kim², Ju Han Kim², Young Joon Hong², Young Keun Ahn², Myung Ho Jeong², Seung Ho Hur⁵, Doo Il Kim⁶, Kiyuk Chang⁷, Hun Sik Park⁸, Jang-Whan Bae⁹, Jin-Ok Jeong¹⁰, Yong Hwan Park¹¹, Kyeong Ho Yun¹², Chang-Hwan Yoon¹³, Yisik Kim¹⁴, Jin-Yong Hwang¹⁵, Hyo-Soo Kim¹⁶, David Hong³, Woochan Kwon³, Ki Hong Choi³, Taek Kyu Park³, Jeong Hoon Yang³, Young Bin Song³, Joo-Yong Hahn³, Seung-Hyuk Choi³, Hyeon-Cheol Gwon³, Joo Myung Lee¹⁷; KAMIR Investigators

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
² Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
³ Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁴ Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea.
⁵ Department of Internal Medicine and Cardiovascular Center, Keimyung University Dongsan Medical Center, Daegu, Korea.
⁶ Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea.
⁷ Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁸ Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
⁹ Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
¹⁰ Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
¹¹ Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
¹² Department of Internal Medicine and Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea.
¹³ Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
¹⁴ Department of Internal Medicine and Cardiovascular Center, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
¹⁵ Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
¹⁶ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
¹⁷ Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: drone80@hanmail.net.

PMID: 38609042
DOI: 10.1016/j.rec.2024.03.009

Abstract

Introduction and objectives: There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

Methods: Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis.

Results: Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P<.001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P<.001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88).

Conclusions: In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.

Keywords: Acute myocardial infarction; Cardiogenic shock; Imagen intravascular; Infarto agudo de miocardio; Intervención coronaria percutánea; Intravascular imaging; Percutaneous coronary intervention; Shock cardiogénico.