What does this research mean for the field?

Intracoronary imaging (ICI) during percutaneous coronary intervention for acute coronary syndrome is associated with significantly lower in-hospital mortality and MACCE, with the benefits primarily observed in procedures involving the left main stem and left anterior descending arteries. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 29, 2023Cardiovascular revascularization medicineOpen Access

Intracoronary imaging in PCI for acute coronary syndrome: Insights from British Cardiovascular Intervention Society registry

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Why the study?

While intracoronary imaging (ICI) guidance is superior to angiography alone, data in all-comer acute coronary syndrome (ACS) patients remain limited.

Does intracoronary imaging-guided PCI reduce in-hospital mortality and MACCE in patients with acute coronary syndrome?

Population

598,921 ACS patients undergoing PCI in England and Wales

Comparison

ICI-guided PCI vs angiography-guided PCI

Design

Retrospective registry-based study

Follow-up

In-hospital

Authors

MZMahvash ZamanWythenshawe Hospital CSChris StevensKeele University PLPeter LudmanInterventional Cardiology

Discussion

Member takes

Implication

Intracoronary imaging-guided PCI was associated with lower ACS mortality and MACCE; leaves open need for randomized confirmation before practice change.

Structured PICO

Does intracoronary imaging-guided PCI reduce in-hospital mortality and MACCE in patients with acute coronary syndrome?

Population

598,921 adults (>18 years) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in England and Wales between 2006 and 2019.

Intervention

Intracoronary imaging (ICI) guided percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS), optical coherence tomography (OCT), or optical frequency domain imaging (OFDI).

Comparator

Angiography-guided percutaneous coronary intervention (PCI) without intracoronary imaging.

Outcome

In-hospital mortalityhard clinical

In an all-comer ACS population, intracoronary imaging-guided PCI was associated with significantly lower in-hospital mortality and MACCE compared to angiography alone, particularly in left main stem and left anterior descending artery interventions.

Limitations

Observational nature, cannot adjust for uncollected variables
Does not report outcomes beyond index hospital admission (e.g., TVR, recurrent MI, MACCE beyond hospital stay)
BCIS database does not capture raw IVUS/OCT measurement data
Cannot distinguish between upfront imaging use or use later in the procedure
Improved outcomes may be confounded by operators' experience and equipment improvement

Cite This Study

Zaman et al. (2023) studied this question.

synapsesocial.com/papers/6a1d1a4d73c56dd1bd2f2d09 https://doi.org/10.1016/j.carrev.2023.05.020

Topics

Percutaneous coronary intervention Coronary artery disease Chronic total occlusion PCI

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Implication

Intracoronary imaging-guided PCI was associated with lower ACS mortality and MACCE; leaves open need for randomized confirmation before practice change.