1
|
Titus A, Majmundar V, Taha A, Patel N, Sooraj M, Omkumar JM, Koshy RM, Saji AM, Sherif AA, Titus A, Kadavath S, Vallabhajosyula S, Nasir K, Dani SS. Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis. Am J Cardiol 2023; 200:95-102. [PMID: 37307785 DOI: 10.1016/j.amjcard.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
Collapse
Affiliation(s)
- Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois
| | - Nirav Patel
- Department of Internal Medicine, Saint Michael Medical Center, Newark, New Jersey
| | - Mannil Sooraj
- Department of Medicine, Chandramma Dayanand Sagar Institute of Medical Education and Research, Bangalore, Karnataka, India
| | - Janaki M Omkumar
- Department of Medicine, Government Medical College, Thrissur, India
| | - Rohan Mathews Koshy
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Akil Adrian Sherif
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, India
| | - Sabeeda Kadavath
- Department of Cardiology, St Bernards Healthcare, Jonesboro, Arkansas
| | | | - Khurram Nasir
- Department of Cardiology, Houston Methodist, Houston, Texas
| | - Sourabh S Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| |
Collapse
|