IVUS-guided PCI reduces risks in patients with diabetes
Intravascular-imaging guided percutaneous coronary intervention (PCI) procedures are associated with improved outcomes for patients with diabetes and acute coronary syndromes (ACS), according to new data published in JACC: Cardiovascular Interventions.[1]
“Angiography has well-known limitations in accurately assessing lesion measurements and stent expansion that may be overcome by intravascular imaging,” wrote first author Xiaofei Gao, MD, a cardiologist with Nanjing First Hospital in China, and colleagues. “Intravascular imaging–guided PCI has been shown to reduce ischemic event rates compared with angiography-guided PCI. However, these findings have not been confirmed in high-risk patients with diabetes presenting with ACS from a randomized clinical trial.”
Gao et al. tracked data from more than 1,100 patients with diabetes and ACS who underwent PCI in China, Italy, Pakistan or the United Kingdom. The mean age was 62 years old, and 68.4% were men. All patients were treated from August 2019 to October 2022.
While 50% of patients were treated with PCI guided by intravascular ultrasound (IVUS), the remaining patients were treated with angiography-guided PCI.
Overall, target vessel failure (TVF)—a composite of cardiac mortality, target vessel myocardial infarction and clinically driven target vessel revascularization (TVR)—was seen in 20 patients from the IVUS group and 46 patients from the angiography group. A Kaplan Meier analysis estimated TVF rates of 3.6% for IVUS-guided PCI and 8.3% for angiography-guided PCI.
This difference in outcomes was primarily driven by a reduction in clinically driven TVR, which was seen in 0.9% of patients from the IVUS group and 3.8% of patients from the angiography group. All-cause mortality was also significantly lower for the IVUS group (0.7%) than the IVUS group (2.4%), though the team’s study was not specifically powered to track that outcome.
The rates of stent thrombosis and major bleeding events, meanwhile, were comparable between the two groups.
Reviewing their findings, Gao and colleagues highlighted the importance of studying the potential benefits of IVUS guidance in high-risk PCI patients.
“The presence of both ACS and diabetes signifies a complex interplay of inflammatory and metabolic processes that can exacerbate the risk for adverse cardiovascular events,” they wrote. “Managing these risks is crucial in the treatment and prevention of ACS in patients with diabetes.”
Click here to read the full analysis in JACC: Cardiovascular Interventions, an American College of Cardiology journal.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.