Long-Term Outcomes of Acute Myocardial Infarction With IVUS Guidance Based on Institutional Use

• Aiming to clarify whether a center’s level of intravascular ultrasound (IVUS) utilization influences the long-term prognostic impact of IVUS-guided percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI).

• Retrospective analysis of 9,752 AMI patients treated with second-generation drug-eluting stents.
• Data drawn from the Korean Acute Myocardial Infarction Registry–National Institutes of Health (KAMIR-NIH).

• IVUS-guided PCI versus non-IVUS-guided PCI.
• Centers categorized by IVUS use into higher-use and lower-use groups using a median institutional usage of 10.3%.

• Primary: 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, and coronary revascularization.
• Secondary: Target-lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target lesion revascularization.

• Higher-use centers: IVUS-guided PCI associated with lower MACE (15.3% vs 18.5%) and lower TLF (6.3% vs 8.3%) in propensity score–matched cohorts.
• Multivariate analysis in higher-use centers: MACE hazard ratio (HR) 0.80 (95% CI 0.69–0.93; P=0.003); TLF HR 0.75 (95% CI 0.59–0.93; P=0.01).
• Lower-use centers: No significant differences with IVUS guidance for MACE (15.7% vs 18.6%; P=0.422) or TLF (8.9% vs 10.4%; P=0.644).

• The favorable association between IVUS guidance and long-term outcomes appears more pronounced and statistically evident in centers with higher IVUS adoption.
• Suggests institutional experience may amplify the observable benefits of IVUS in AMI management.

• Study is observational and center-based; residual confounding could influence associations.
• Not all components (e.g., procedural nuances, IVUS interpretation proficiency) are fully detailed in the provided content.

Whether these results generalize to other populations or newer devices requires further investigation.

• The findings underscore the potential value of standardized IVUS implementation and broader, consistent IVUS use in AMI care, particularly in centers with established IVUS practice.