Key result
Intracoronary imaging-guided PCI linked to ~35% lower in-hospital MACCE in cardiogenic shock.
Why the study?
Limited data exist regarding the utility of intracoronary imaging during PCI in patients with ACS and cardiogenic shock, who face high risks of stent thrombosis.
Is intracoronary imaging-guided PCI associated with lower in-hospital MACCE and all-cause mortality compared with angiography-guided PCI in patients with acute coronary syndrome and cardiogenic shock?
Cohort (n=15,738)
Yes
Is intracoronary imaging-guided PCI associated with lower in-hospital MACCE and all-cause mortality compared with angiography-guided PCI in patients with acute coronary syndrome and cardiogenic shock?
In patients with ACS and cardiogenic shock undergoing PCI, intracoronary imaging guidance remains under-utilized (<1 in 6 by 2020) despite being associated with a 35% lower adjusted odds of in-hospital MACCE and all-cause mortality.
Answers are grounded in this paper and cite their sources.
May support imaging guidance in shock PCI; extends observational data but leaves open need for RCTs before practice change.
BACKGROUND: Limited data exist around the utility of intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and cardiogenic shock (CS), who are inherently at a high risk of stent thrombosis (ST). METHODS: All PCI procedures for ACS patients with CS in England and Wales between 2014 and 2020 were retrospectively analysed, stratified into two groups: ICI and angiography-guided groups. Multivariable logistic regression analyses were performed to examine odds ratios (OR) of in-hospital outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE; composite of all-cause mortality, acute stroke/transient ischaemic attack (TIA), and reinfarction) and major bleeding, in the ICI-guided group compared with angiography-guided PCI. RESULTS: Of 15,738 PCI procedures, 1240(7.9%) were ICI-guided. The rate of ICI use amongst those with CS more than doubled from 2014 (5.7%) to 2020 (13.3%). The ICI-guided group were predominantly younger, males, with a higher proportion of non-ST-elevation ACS and ST. MACCE was significantly lower in the ICI-guided group compared with the angiography-guided group (crude: 29.8% vs. 38.2%, adjusted odds ratio (OR) 0.65 95% confidence interval [CI] 0.56-0.76), driven by lower all-cause mortality (28.6% vs. 37.0%, OR 0.65 95% CI 0.55-0.75). There were no differences in other secondary outcomes between groups. CONCLUSION: ICI use among CS patients has more than doubled over 6 years but remains significantly under-utilized, with less than 1-in-6 patients in receipt of ICI-guided PCI by 2020. ICI-guided PCI is associated with prognostic benefits in CS patients and should be more frequently utilized to increase their long-term survival.
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Mohamed et al. (2023) conducted a cohort in Acute coronary syndrome with cardiogenic shock undergoing percutaneous coronary intervention (n=15,738). Intracoronary imaging-guided PCI (IVUS or OCT) vs. Angiography-guided PCI was evaluated on In-hospital major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause mortality, acute stroke/transient ischaemic attack, and reinfarction) (OR 0.65, 95% CI 0.56-0.76, p=<0.001). Intracoronary imaging-guided PCI was associated with lower in-hospital MACCE (29.8% vs 38.2%; adjusted OR 0.65, 95% CI 0.56-0.76, p<0.001) and mortality vs angiography guidance in cardiogenic shock.
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