Benefit of IVUS-guided PCI in diabetic patients presented with acute myocardial infarction- from Korea acute myocardial infarction registry

Purpose: Intravascular ultrasonography (IVUS) has been widely used in percutaneous coronary intervention (PCI) field. Precise measurement of reference vessel and early detection of various complications which cannot be distinguished by angiographic image led the outcome of IVUS-guided PCI more favorable. However, its beneficial effect was not thoroughly evaluated in the setting of acute myocardial infarction. Some studies documented that in the cases of AMI, IVUS-guided PCI was not superior to the conventional angiography guided PCI. We hypothesized that certain subjects such as patients with diabetes mellitus (DM) might receive benefits from IVUS-guided PCI. Methods: Patients were from Korea Acute Myocardial Infarction Registry (KAMIR) data. KAMIR was the retrospective observational study from 52 tertiary hospitals commemorating of the 50th anniversary of Korea Society of Cardiology. From 16,264 patients, 3,339 of consecutive patients were enrolled in this study. Patients with DM presented with AMI and received PCI were divided to two groups according to the use of IVUS during the procedure; IVUS group (n=683, 20.5%) and control group (n=2,656, 79.5%). Primary outcome was major adverse cardiovascular event (MACE) at one year follow up. Secondary outcomes were each component of MACE and stent thrombosis. Results: Mean age was 63.1 years and almost 75% were male. Patients in the IVUS group were younger and had better Killip class, more anterior infarction and target organ damage than the control group. They received longer, larger and more stents compared to patients in the control group. One month MACE was significantly lower in the IVUS group compared to the control group (4.6% vs. 10.6%, p<0.0001). Except for the one month death rate, other components of one month MACE were similar between the two groups. One month death rate was significantly lower in the IVUS group. Similar pattern was shown in the one year MACE. One year MACE was significantly lower in the IVUS group (10.1% vs. 15.1%, p=0.001). Also, but for the lower rate of one year death rate, other components showed no significant differences between two groups. One year stent thrombosis was not different, too (1.6% vs. 2.4%). However, after the multivariate logistic regression analysis, use of IVUS was not a significant predictor neither for one month MACE nor for one year MACE. This results reveals that this registry data represents IVUS was mostly done in patients with hemodynamic stable. Conclusion: From our study, IVUS-guided PCI was not associated with favorable clinical outcomes in diabetic patients with AMI.