Introduction: Although intravascular ultrasound (IVUS) has been widely used in clinical settings. Lately, favorable results of IVUS-guided percutaneous coronary intervention (PCI), compared with Angio-guided PCI, were observed in previous studies. But in the case of Acute Coronary Syndrome(ACS), the effect of IVUS for clinical events are limited.
Methods: The Kumamoto Intervention Conference Study (KICS) is multicenter registry enrolling consecutive patients undergoing PCI in 16 centers in Japan and 11,335 consecutive procedures were enrolled in this registry. To elucidate the impact of IVUS usage in the case of ACS, 6,025 subjects after successful PCI with 12-month follow-up data were enrolled.
Results: In overall analysis, higher age, urgent PCI, and prior MI were negative predictors for IVUS usage. Critical adverse events (cardiac event, cardiac death, nonfatal myocardial infarction and stent thrombosis) during 12-month follow up were significantly lower in the IVUS-guided group than in the Angio-guided group (4.2% vs 1.9%, 2.7% vs 1.3%, 1.5% vs 0.6%, 1.3% vs 0.6%, p<0.01, respectively). Kaplan-Meier analyses for cardiac death showed a significant difference between the 2 groups. In subgroup analysis, favorable results for IVUS usage in cardiac death were consistent with various patient status (in patients with DM, CKD, urgent PCI, BMS and DES). Even after adjustment by propensity-score matching with predictive factors for cardiac death, favorable utility of IVUS was observed in prognostic events.
Conclusions: In Japanese ACS patients treated with IVUS-guided PCI, the rates of adverse cardiovascular events were significantly lower than with angiography-guidance alone, regardless of patient status in PCI, stent type, or comorbid conditions.