Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA lesion classification

Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA lesion classification https://doi.org/10.1016/j.rec.2025.12.001 Abstract Introduction and objectives: Despite the favorableprognosis associated with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) for complex coronary lesions, it is still unclear whether intravascular imaging -guided percutaneous coronary intervention forsuch 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 acute myocardial infarction registries. We identified 23 051 patients from KAMIR-V and KAMIR-NIH who underwent successful percutaneous coronary intervention for an infarct-related artery and stratified them by the ACC/AHAlesion classification. Clinical outcomes were compared between intravascular imaging -guided and angiography-guided percutaneous coronary intervention. Theprimary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, acute myocardial infarction, repeat revascularization, and stent thrombosis, at 3 years. Results: intravascular imaging -guided percutaneouscoronary intervention demonstrated a lower incidence of MACE compared with angiography-guided percutaneous coronary intervention in patients with type B2/C lesions (adjusted HR, 0.78; 95%CI, 0.70-0.88; P < .001), but not inpatients 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 major adversecardiac events following intravascular imaging -guided percutaneous coronary intervention than angiography-guided percutaneous coronary intervention 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 acute myocardialinfarction, intravascular imaging -guided percutaneous coronary intervention was associated with a significantly lower risk of major adverse cardiac events in those with type B2/C lesions, but not in those with type A/B1 lesions. Theprognostic benefit of intravascular imaging -guided percutaneous coronary intervention increased with greater lesion complexity in the infarct-related artery. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.