The Clinical Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients with High Thrombus Burden
Jinhwan Jo MD , Hyun Sung Joh MD , Hyun Kuk Kim MD, PhD , Ju Han Kim MD, PhD , Young Joon Hong MD, PhD , Young Keun Ahn MD, PhD , Myung Ho Jeong MD, PhD , Seung Ho Hur MD, PhD , Doo-Il Kim MD, PhD , Kiyuk Chang MD, PhD , Hun Sik Park MD, PhD , Jang-Whan Bae MD, PhD , Jin-Ok Jeong MD, PhD , Yong Hwan Park MD, PhD , Kyeong Ho Yun MD, PhD , Chang-Hwan Yoon MD, PhD , Yisik Kim MD, PhD , Jin-Yong Hwang MD, PhD , Hyo-Soo Kim MD, PhD , Woochan Kwon MD , Joo Myung Lee MD, MPH, PhD
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引用次数: 0
Abstract
Despite the established clinical efficacy following intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) than angiography-guided PCI, evidence regarding prognostic benefits of IVI-guided PCI in acute myocardial infarction (AMI) patients with high thrombus burden remains limited. Using the nationwide registries of KAMIR-NIH and KAMIR-V, we evaluated the prognostic impact of IVI-guided PCI in AMI patients with high thrombus burden. A total of 4,074 patients with AMI and TIMI thrombus grades 4 or 5 who underwent aspiration thrombectomy were selected, of whom 892 patients (21.9%) received IVI-guided PCI and 3,182 patients (78.1%) received angiography-guided PCI. Primary outcome was major adverse cardiovascular event (MACE, a composite of all-cause death, MI, repeat revascularization, and stent thrombosis). Major secondary efficacy outcome was cardiac death and safety outcome was stroke at 3 years. During the median 3 years of follow-up, the risk of MACE was significantly lower in the IVI-guided PCI group than in the angiography-guided PCI group (12.9% vs 16.3%; adjusted HR, 0.80; 95% CI, 0.65 to 0.98; p = 0.035), mainly driven by a lower risk of all-cause death (5.7% vs 10.0%; adjusted HR, 0.65; 95% CI, 0.48 to 0.89; p = 0.007). IVI-guided PCI also showed lower risk of cardiac death compared with angiography-guided PCI (3.8% vs 7.0%; adjusted HR, 0.65; 95% CI, 0.44 to 0.95; p = 0.025). There was no significant difference in the risk of stroke between the groups. In this hypothesis generating study, IVI-guided PCI was associated with a lower risk of MACE and cardiac death than angiography-guided PCI in AMI patients with high thrombus burden.
尽管血管内成像(IVI)引导下的经皮冠状动脉介入治疗(PCI)的临床疗效优于血管造影引导下的PCI,但关于IVI引导下的PCI在高血栓负担的急性心肌梗死(AMI)患者中的预后益处的证据仍然有限。使用全国性的KAMIR-NIH和KAMIR-V注册表,我们评估了ivi引导的PCI对高血栓负担AMI患者的预后影响。共选择4074例AMI和TIMI血栓4级或5级患者行吸入性取栓术,其中892例(21.9%)行ivi引导下PCI, 3182例(78.1%)行血管造影引导下PCI。主要终点是主要心血管不良事件(MACE,全因死亡、心肌梗死、重复血运重建术和支架血栓形成的综合结果)。主要的次要疗效终点是心源性死亡,3年时的安全性终点是卒中。在中位3年随访期间,ivi引导下PCI组MACE风险显著低于血管造影引导下PCI组(12.9% vs. 16.3%;调整HR为0.80;95% CI为0.65 ~ 0.98;P=0.035),主要原因是全因死亡风险较低(5.7% vs. 10.0%;调整HR为0.65;95% CI为0.48 ~ 0.89;P=0.007)。与血管造影引导下的PCI相比,ivi引导下的PCI也显示出更低的心源性死亡风险(3.8% vs. 7.0%;调整后风险比为0.65;95% CI为0.44-0.95;P=0.025)。两组之间中风的风险没有显著差异。在这项假设生成研究中,在血栓负担高的AMI患者中,ivi引导下的PCI与MACE和心源性死亡的风险比血管造影引导下的PCI低。
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.