What does this research mean for the field?

In patients with ST-elevation myocardial infarction, intravascular ultrasound (IVUS)-guided PCI does not significantly improve in-hospital mortality compared to angiography-guided PCI, but is associated with higher costs and an increased risk of coronary artery dissection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 2, 2020Journal of Community Hospital Internal Medicine PerspectivesOpen Access

In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients

View Full Paper

Ask AI

Bookmark

Why the study?

In-hospital complications, outcomes, cost, and length of stay between angiography-guided PCI and IVUS-guided PCI in STEMI patients in the USA had not been directly compared.

Does IVUS-guided PCI improve in-hospital mortality and complications compared to angiography-guided PCI in adult patients with STEMI?

Population

100,485 angiography-guided PCI and 5,460 IVUS-guided PCI patients >18 years with STEMI in the USA

Comparison

Angiography-guided PCI vs IVUS-guided PCI

Design

Nationwide inpatient database study

Authors

MKMazin KhalidUniversity of Maryland, Baltimore MKMazin KhalidUniversity of Maryland, Baltimore NPNeelkumar PatelMaimonides Medical Center

Discussion

Member takes

Implication

IVUS-guided PCI was not associated with lower in-hospital mortality in STEMI; leaves open whether randomized trials would show benefit.

Structured PICO

Does IVUS-guided PCI improve in-hospital mortality and complications compared to angiography-guided PCI in adult patients with STEMI?

Population

105,945 adult patients (aged ≥18 years) with STEMI who underwent PCI (excluding those requiring CABG in the same admission), mean age 62, 28.96% female, US-based (NIS database 2016).

Intervention

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI)

Comparator

Standard angiography-guided percutaneous coronary intervention (PCI)

Outcome

In-hospital mortalityhard clinical

In patients with STEMI, IVUS-guided PCI did not significantly reduce in-hospital mortality compared to angiography-guided PCI, but was associated with higher hospital costs and increased reported rates of coronary artery dissection.

Limitations

Coding system errors inherent to the NIS database
Retrospective observational design with potential residual selection bias despite propensity matching
Lack of information on stent types, culprit vessel, TIMI flow, stent sizing, and number of vessels revascularized
Inability to determine if coronary dissection was the primary cause of STEMI (SCAD) or a procedural complication
Lack of post-discharge and long-term outcomes data (e.g., stent thrombosis)
Cost analysis excluded short- and long-term rehabilitation facility expenses

Cite This Study

Khalid et al. (2020) studied this question.

synapsesocial.com/papers/6a1970a2001a20a9c0d96dd2 https://doi.org/10.1080/20009666.2020.1800970

Topics

STEMI management Percutaneous coronary intervention

View Full Paper

Ask AI

Bookmark

In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider