Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis
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-hospi...
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| Veröffentlicht in: | The American journal of cardiology 2023-08, Vol.200, p.95-102 |
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| creator | Titus, Anoop Majmundar, Vidit Taha, Amro Patel, Nirav Sooraj, Mannil Omkumar, Janaki M. Koshy, Rohan Mathews Saji, Anu Mariam Sherif, Akil Adrian Titus, Aishwarya Kadavath, Sabeeda Vallabhajosyula, Saraschandra Nasir, Khurram Dani, Sourabh S. |
| description | 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 |
| doi_str_mv | 10.1016/j.amjcard.2023.05.022 |
| format | Article |
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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.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.05.022</identifier><identifier>PMID: 37307785</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Angioplasty ; Cardiology ; Cardiovascular disease ; Chi-square test ; Clinical outcomes ; Clinical trials ; Codes ; Complications ; Coronary Angiography ; Coronary Artery Disease ; Coronary vessels ; Heart attacks ; Hospitalization ; Humans ; Morbidity ; Mortality ; Myocardial infarction ; Non-ST Elevated Myocardial Infarction ; Normal distribution ; Patients ; Percutaneous Coronary Intervention ; Prospective Studies ; Regression Analysis ; Regression models ; Statistical analysis ; Stroke ; Treatment Outcome ; Trends ; Ultrasonic imaging ; Ultrasonography, Interventional ; Ultrasound</subject><ispartof>The American journal of cardiology, 2023-08, Vol.200, p.95-102</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c341t-25035cd059b5525d0359930764e710f7c9052b224071cae3fc548102badff37c3</cites><orcidid>0000-0002-2102-9529 ; 0000-0002-3434-6136</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2834056865?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37307785$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Titus, Anoop</creatorcontrib><creatorcontrib>Majmundar, Vidit</creatorcontrib><creatorcontrib>Taha, Amro</creatorcontrib><creatorcontrib>Patel, Nirav</creatorcontrib><creatorcontrib>Sooraj, Mannil</creatorcontrib><creatorcontrib>Omkumar, Janaki M.</creatorcontrib><creatorcontrib>Koshy, Rohan Mathews</creatorcontrib><creatorcontrib>Saji, Anu Mariam</creatorcontrib><creatorcontrib>Sherif, Akil Adrian</creatorcontrib><creatorcontrib>Titus, Aishwarya</creatorcontrib><creatorcontrib>Kadavath, Sabeeda</creatorcontrib><creatorcontrib>Vallabhajosyula, Saraschandra</creatorcontrib><creatorcontrib>Nasir, Khurram</creatorcontrib><creatorcontrib>Dani, Sourabh S.</creatorcontrib><title>Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>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.</description><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Chi-square test</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Codes</subject><subject>Complications</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease</subject><subject>Coronary vessels</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Non-ST Elevated Myocardial Infarction</subject><subject>Normal distribution</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention</subject><subject>Prospective Studies</subject><subject>Regression Analysis</subject><subject>Regression models</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Treatment Outcome</subject><subject>Trends</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, 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of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis</title><author>Titus, Anoop ; Majmundar, Vidit ; Taha, Amro ; Patel, Nirav ; Sooraj, Mannil ; Omkumar, Janaki M. ; Koshy, Rohan Mathews ; Saji, Anu Mariam ; Sherif, Akil Adrian ; Titus, Aishwarya ; Kadavath, Sabeeda ; Vallabhajosyula, Saraschandra ; Nasir, Khurram ; Dani, Sourabh S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c341t-25035cd059b5525d0359930764e710f7c9052b224071cae3fc548102badff37c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute coronary syndromes</topic><topic>Angioplasty</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Chi-square test</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Codes</topic><topic>Complications</topic><topic>Coronary 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Anoop</au><au>Majmundar, Vidit</au><au>Taha, Amro</au><au>Patel, Nirav</au><au>Sooraj, Mannil</au><au>Omkumar, Janaki M.</au><au>Koshy, Rohan Mathews</au><au>Saji, Anu Mariam</au><au>Sherif, Akil Adrian</au><au>Titus, Aishwarya</au><au>Kadavath, Sabeeda</au><au>Vallabhajosyula, Saraschandra</au><au>Nasir, Khurram</au><au>Dani, Sourabh S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>200</volume><spage>95</spage><epage>102</epage><pages>95-102</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37307785</pmid><doi>10.1016/j.amjcard.2023.05.022</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2102-9529</orcidid><orcidid>https://orcid.org/0000-0002-3434-6136</orcidid></addata></record> |
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| ispartof | The American journal of cardiology, 2023-08, Vol.200, p.95-102 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Acute coronary syndromes Angioplasty Cardiology Cardiovascular disease Chi-square test Clinical outcomes Clinical trials Codes Complications Coronary Angiography Coronary Artery Disease Coronary vessels Heart attacks Hospitalization Humans Morbidity Mortality Myocardial infarction Non-ST Elevated Myocardial Infarction Normal distribution Patients Percutaneous Coronary Intervention Prospective Studies Regression Analysis Regression models Statistical analysis Stroke Treatment Outcome Trends Ultrasonic imaging Ultrasonography, Interventional Ultrasound |
| title | Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non–ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis |
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