This document summarizes a retrospective cohort study that analyzed data from the COREA-AMI registry to compare long-term clinical outcomes of IVUS-guided PCI versus angiography-guided PCI in patients with acute myocardial infarction (AMI). The study found that IVUS-guided PCI was associated with reduced risks of major adverse cardiovascular events, cardiovascular death, myocardial infarction, and target lesion revascularization compared to angiography-guided PCI. However, the study was limited by its retrospective design and selection bias in how IVUS was used. Randomized controlled trials are still needed to provide stronger evidence on whether IVUS guidance specifically improves outcomes for AMI patients.

1. JOURNAL CLUB

4. INTRODUCTION
 Intravascular ultrasound (IVUS) is a useful tool for overcoming the
limitations of conventional PCI.
 IVUS-guided PCI may optimize stent implantation and improve
clinical outcomes.
 Therefore, IVUS has been widely used in the contemporary PCI era.
 Current guidelines recommend intravascular imaging to optimize
stent implantation and treatment of left main disease(ESC IIa)

5.  A meta-analysis demonstrated that IVUS reduces restenosis and
stent thrombosis, but whether it can reduce mortality remains
controversial.
 In addition, few data are available on current patterns of IVUS use
in patients with acute myocardial infarction (AMI).

6. Impact of Intravascular Ultrasound on Long-Term
Clinical Outcomes in Patients With Acute
Myocardial Infarction
PREPARED:
IKRAM SHINWARI

7. METHODs
 STUDY DESIGN: Retrospective cohort study
 STUDY POPULATION : COREA-AMI registry 9846 patients were
included. 2 GROUPS:
a) IVUS guided PCI n=2,032
b) Angio guided PCI n= 7,184
 STUDY DURATION
1. COREA-AMI 1 (January 2004- December 2009)
2. COREA-AMI 2 (January 2010- August 2014)
 DATA COLLECTION: web based system
 STATISTICAL ANALYSIS: SPSS v20
 FOLLOW UP: 2019…… 4 years.

8. INCLUSION CRITERIA:
1.Older than 20 years
2.Treated with PCI with DES.
EXLUSION CRITERIA:
1.Balloon angioplasty or thrombus aspiration.
2.Bare-metal stents.
3.Optical coherence tomography–guided PCI.

10. ENDPOINTS
 The primary endpoint was major adverse cardiovascular events
(MACEs), including cardiovascular death, myocardial infarction (MI),
and target lesion revascularization (TLR).
 Secondary endpoints were cardiovascular death, MI, TLR, definite or
probable stent thrombosis, and all-cause death.

11. DEFINITIONS
 Cardiovascular death: Death resulting from AMI, sudden cardiac death,
heart failure, stroke, or other vascular cause. Deaths without definitive
noncardiovascular causes were considered cardiovascular deaths.
 Recurrent MI: Elevated cardiac marker(s) with evidence of ischemia such
as a typical symptom, electrocardiographic changes, or appropriate
anatomical or functional results.

12.  TLR : Any unscheduled repeat PCI in a previously treated segment
from 5 mm proximal to 5 mm distal to the stent with significant
stenosis and recurrence of chest pain or evidence of ischemia
 In the subgroup analysis, complex PCI was defined as one of the
following: 1) bifurcation lesion; 2) chronic total occlusion (CTO)
lesion; 3) PCI for left main lesion; 4) multivessel disease; 5)
restenosis lesion; 6) long lesion (total length of stents >=60 mm);
and 7) number of implanted stents >=3.

13. RESULTS
BASELINE CHARACTERISTICS:

15. CLINICAL OUTCOMES

19. DISCUSSION
1. IVUS-guided PCI was more beneficial than angiography-guided PCI
during the long-term follow-up duration.
2. Procedural complications did not differ between the groups
3. IVUS guided PCI was associated with a reduced risk for MACEs,
cardiovascular death, MI, and TLR compared with angiography-
guided PCI.
4. In the subgroup analysis at the patient and lesion levels, the impact
of IVUS-guided PCI was greatest in patients with CKD and PCI for
left main lesions.

20.  This study was conducted from 2004-2014. while previous study
was of 1 year duration
 The use of IVUS in the acute setting of PCI for AMI is associated
with a lower risk for long-term adverse events. In contrast, another
registry showed that IVUS-guided PCI was not associated with a
lower risk for clinical events after adjusting for confounders

21.  The other registry included only patients with STEMI from 2005 to
2007, and only one fifth of the patients received DES. In contrast,
registry included patients with STEMI and NSTEMI from 2004 to
2014, and bare-metal stent implantation was excluded
 The stent optimization with IVUS during interventions for AMI may
be associated with a reduced risk for CV death within 1 year and a
reduced risk for culprit MI and TLR more than 1 year after the index
PCI. Previous studies have reported inconsistent results in terms of
the durations and beneficial clinical outcomes.

22.  In the subgroup analysis, IVUS-guided PCI may be expected to be
more useful in PCI for left main lesions. In contrast, in a recent large
study that included more than 100,000 uses of IVUS, a subgroup
analysis showed that IVUS was more effective for noncomplex
lesions than complex lesions. These findings of the subgroup
analysis were not conclusive, and further studies are needed to
confirm the effectiveness of IVUS-guided PCI for certain clinical
settings

23. LIMITATIONS
 Retrospective cohort study. Unknown confounders may have
affected the outcome.
 The selection of IVUS was made at the treating physician’s
discretion.
 Registry data did not include detailed IVUS parameters
 Subgroup analyses did not have sufficient statistical power.

24. CONCLUSIONS
 IVUS can be safely used without increasing procedural
complications .
 IVUS-guided PCI was independently associated with a decreased
risk for long-term cardiovascular events in patients with AMI
undergoing PCI with DES.
 The beneficial effects of IVUS persisted for more than 1 year after
index PCI.
 The use of IVUS in PCI should be considered for patients with AMI.

25. WHAT IS NEXT?
Future randomized controlled studies comparing IVUS-
guided PCI and angiography guided PCI in patients with
AMI are necessary to clarify whether the use of IVUS
during PCI is beneficial for patients with AMI

26. THANK YOU