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

Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock Rev Esp Cardiol (Engl Ed) . 2024 Dec;77(12):995-1007. Abstract Introduction and objectives: There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided percutaneous coronary intervention in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction 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 acute myocardial infarction and cardiogenic shock who underwent percutaneous coronary intervention 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 percutaneous coronary intervention and 1458 patients (79.5%) underwent angiography-guided percutaneous coronary intervention. Intravascular imaging-guided percutaneous coronary intervention was associated with a significantly lower risk of 1-year major adverse cardiovascular events than angiography-guided percutaneous coronary intervention (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 acute myocardial infarction patients with cardiogenic shock, intravascular imaging-guided percutaneous coronary intervention was associated with a lower risk of major adverse cardiovascular events at 1-year than angiography-guided percutaneous coronary intervention, mainly driven by the lower risk of cardiac death. 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 ­­­STAR UPDATE 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.