In patients with acute coronary syndrome (ACS), intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) resulted in a lower one-year rate of the composite outcome of cardiac death, target vessel myocardial infarction, or clinically driven revascularisation compared with angiography guidance alone.
This is the finding of a two-stage, multicentre, randomised trial—IVUS-ACS—published in The Lancet and presented at the American College of Cardiology (ACC) 2024 scientific session (6–8 April, Atlanta, USA) by study author Xiang Chen (Xiamen University, Xiamen, China).
Intravascular ultrasound-guided percutaneous coronary intervention has been shown to result in superior clinical outcomes compared with angiography-guided PCI, Chen and colleagues write in their Lancet paper, but they note that insufficient data are available concerning the advantages of intravascular ultrasound guidance for patients with ACS.
IVUS-ACS, therefore, aimed to investigate whether the use of IVUS guidance, as compared with angiography guidance, improves the outcomes of PCI with contemporary drug-eluting stents in patients presenting with ACS.
Investigators randomised patients aged 18 years or older and presenting with ACS at 58 centres in China, Italy, Pakistan, and the UK to IVUS- or angiography-guided PCI. Patients, follow-up healthcare providers, and assessors were masked to random assignment; however, staff in the cath lab were not.
The primary endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularisation at one year after randomisation.
Between August 2019 and October 2022, Chen and colleagues randomised 3,505 patients with ACS to IVUS-guided PCI (n=1,753) or angiography-guided PCI (n=1,752).
One-year follow-up was completed in 3,504 (>99·9%) patients. The primary endpoint occurred in 70 patients in the intravascular ultrasound group and 128 patients in the angiography group, driven by reductions in target vessel myocardial infarction or target vessel revascularisation, the investigators report. There were no significant differences in all-cause death or stent thrombosis between groups. Safety endpoints were also similar in the two groups.
