NEW YORK (Reuters Health) – In patients with acute MI undergoing percutaneous coronary intervention, routine use of intravascular ultrasound to guide stent placement is not associated with better survival at 12 months, a Korean group reports.

Writing in the American Journal of Cardiology online May 2, Dr. Myung Ho Jeong at Chonnam National University Hospital in Gwangju, Korea, and colleagues point out that intravascular ultrasound (IVUS) guidance during elective PCI has been shown to reduce the rate of restenosis and target vessel revascularization. However, the use of IVUS guidance in the setting of acute MI remains controversial.

The authors therefore looked data in the Korea Acute Myocardial Infarction Registry on 2,127 patients who underwent IVUS-guided primary PCI compared to 8,235 patients who did not. The primary end point was a major adverse cardiac event, defined as the composite of all-cause death, nonfatal MI, and target vessel revascularization, at 12-month follow-up.

MACE rates were very similar in the two groups, occurring in 6.6% of the IVUS patients compared with 6.1% in the non-IVUS group (p=0.295).

Unadjusted all-cause mortality rates were significantly different at 1.0% vs 2.0% (p=0.006), respectively, the investigators found. However, on multivariate analysis, IVUS guidance was not an independent predictor of 12-month all-cause death (hazard ratio 0.202; p=0.131). This hardly changed with propensity score adjustment (HR 0.212; p=0.148).

“This result is unanticipated,” Dr. Jeong and colleagues comment. Nonetheless, they conclude, “Our study does not support routine use of IVUS guidance for stent deployment in patients who present with acute MI and undergo PCI.”

Reference:
Role of Intravascular Ultrasound in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
SOURCE: Am J Cardiol 2011.