The Association Between Intravascular Ultrasound-guided Primary Percutaneous Intervention And Coronary Function And Clinical Outcome:A Observational Study

Intravascular ultrasound(IVUS)is a novel intracoronary imaging modality and shows improvement in the assessment of luminal stenosis and lesion structure compared to coronary angiography.Over the decades,many clinical studies have shown that IVUS-guided elective percutaneous coronary intervention is associated with a lower rate of target lesion revascularization and lower mortality.However,it remains controversial whether the use of intravascular ultrasound during primary percutaneous coronary intervention is effective in improving clinical outcomes.The aim of the present study was to evaluate the impact of IVUS-guided primary percutaneous coronary intervention in real-life clinical practice.This is a multicentre,prospective,observational study.We enrolled patients presented with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention in three centres on a continuous basis from January 2019 to January 2021.Patients were divided into a angiography-guided group(n=255)and an IVUS-guided group(n=93)according to whether IVUS was used.The 1-year incidence of major adverse cardiovascular events(including death,recurrent myocardial infarction,heart failure,unstable angina),coronary artery physiological function(quantitative flow ratio:QFR),and coronary microcirculatory status(angiography-derived microcirculatory resistance index:AMR;difference between contrast QFR and fixed QFR:cQFR-fQFR)were compared between the two groups,as well as patients’ cardiac function during hospitalisation.Propensity score matching was performed to adjust for confounding,and the analysis was repeated after propensity score matching.Levels of cQFR-fQFR(-0.0036±0.0324 vs.0.0047±0.0290,p=0.025)were significantly lower in the IVUS-guided group than in the coronary angiography-guided group,with no difference in QFR or AMR between the two groups.Peak brain natriuretic peptide/N-terminal precursor brain natriuretic peptide exceeded the 10-fold upper limit in only 2 patients(2.2%)in the IVUS-guided group during hospitalisation,significantly fewer than in 39 patients(15.3%)in the coronary angiography group,while left ventricular ejection fraction and left ventricular end-systolic diameter were not significantly different between the two groups.In total,26(10.2%)in the coronary angiography group and 4(4.3%)in the intravascular ultrasound group experienced major adverse cardiac events,with no significant differences between the two groups.After propensity scoring,there were no differences in postoperative coronary physiological function and microcirculatory status between the two groups in the overall population,and in non-smoking and overweight patients,AMR was significantly lower in the IVUS-guided group than in the angiography-guided group.The incidence of myocardial infarction and major adverse cardiac events during 1 year follow-up was also significantly higher in the angiography guidance group than in the IVUS guidance group(4%vs.14.7%,p=0.022).In cox regression analysis,the use of intravascular ultrasound remained an independent protective factor for major adverse cardiac events(model Ⅲ,HR=0.175,95%CI 0.043,0.715,P=0.015).In this study,the use of intravascular ultrasound during primary percutaneous coronary intervention improved the clinical prognosis of patients with ST-elevation myocardial infarction and may be beneficial in improving coronary microcirculatory function.