IVUS-guided PCI beats angiography in patients with acute coronary syndrome

In patients with acute coronary syndrome (ACS), IVUS-guided percutaneous coronary intervention (PCI) reduced target vessel failure at 1 year compared with angiography-guided PCI in the IVUS-ACS trial. This benefit was driven by reductions in target vessel myocardial infarction and target vessel revascularisation.

Until recently, only 3 small randomised-controlled trials of intravascular imaging-guided versus angiography-guided PCI have been performed in patients with ACS patients. Therefore, the aim of the IVUS-ACS trial (NCT03971500), presented by Prof. Shao-Liang Chen (Nanjing Medical University, China), was to investigate whether IVUS guidance compared with angiography guidance improves the outcomes of PCI in these patients.

All participants presented with ACS within 30 days before randomisation. The analysis included 3,505 participants from 58 centres in China (over 2,000 of the participants), Italy, Pakistan, and the UK, who were randomised to IVUS-guided PCI (n=1,753) or angiography-guided PCI (n=1,752). In the IVUS group,  39.9% had unstable angina, 32.5% had a non-ST elevation myocardial infarction (STEMI), and 27.6% had a STEMI. The percentages in the angiography-guided group were similar: 41.4% unstable angina, 30.7% non-STEMI, and 27.9% STEMI.

The primary study endpoint was target vessel failure, a composite of cardiac death, target vessel MI, or clinically-driven target vessel revascularisation 1 year after randomisation. At this time, 4.0% in the IVUS-guided PCI group compared with 7.3% of participants in the angiography-guided PCI group reached this endpoint, a highly significant difference (HR 0.55; 95% CI 0.41–0.74; P<0.0001) driven by reductions in target vessel MI and target vessel revascularisation. The safety outcomes were similar between the 2 groups.

Prof. Chen pointed out that all subgroups (including participants with diabetes, multivessel disease, or those receiving antiplatelet therapy) benefitted from the IVUS-guided stent implantation independent of whether they had unstable angina, a STEMI, or non-STEMI.

1. 
   
   1. Chen SL, et al. Intravascular Ultrasound-guided Versus Angiography-guided Percutaneous Coronary Intervention in Acute Coronary Syndromes: The Multicenter, Randomized, Blinded, IVUS-ACS Trial. Featured Clinical Research 3, Session 413, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

Medical writing support was provided by Dr Susanne Kammerer
Copyright ©2024 Medicom Medical Publishers



Posted on 11 April, 202418 April, 2024