IVUS-ACS Trial Summary
Introduction
In the management of acute coronary syndrome (ACS), optimal guidance for percutaneous coronary intervention (PCI) remains a critical factor in improving patient outcomes. The IVUS-ACS trial, a large, multicenter, randomized study, investigates whether intravascular ultrasound (IVUS)-guided PCI provides superior results compared to conventional angiography-guided PCI in patients with ACS. This trial aims to determine if IVUS guidance reduces adverse cardiac events and improves long-term patient outcomes.
Study Design
- Trial Type: Two-stage, multicenter, randomized controlled trial
- Participants: 3,505 patients
- Comparison Groups:
- IVUS-guided PCI (n=1,753)
- Angiography-guided PCI (n=1,752)
- Inclusion Criteria: Patients aged 18 years or older diagnosed with ACS, including unstable angina, NSTEMI, and STEMI, who had significant coronary stenosis (≥90%) or other high-risk coronary features requiring PCI.
Primary Outcome
The trial evaluated target vessel failure, a composite outcome including:
- Cardiac death
- Target vessel myocardial infarction (MI)
- Clinically driven target vessel revascularization within 1 year of randomization
Results:
- IVUS-guided PCI: 4.0%
- Angiography-guided PCI: 7.3%
- Hazard Ratio (HR): 0.55 (95% CI: 0.41-0.74, P = 0.0001)
These findings suggest that IVUS guidance significantly reduced the risk of target vessel failure compared to angiography alone.
Secondary Outcomes
- The trial also evaluated all-cause death or stent thrombosis, but specific outcome data for this measure were not detailed in the summary.
Key Takeaways & Clinical Implications
- Superior Efficacy of IVUS: The trial demonstrates that IVUS-guided PCI significantly reduces the composite risk of cardiac death, target vessel MI, and repeat revascularization compared to angiography-guided PCI.
- Clinical Application: These results support the increased use of IVUS guidance in complex PCI cases, particularly in ACS patients requiring drug-eluting stents.
- Potential for Change in Guidelines: Given the robust reduction in target vessel failure, IVUS guidance may gain stronger recommendations in clinical practice guidelines for PCI in ACS.
Conclusion
The IVUS-ACS trial provides compelling evidence that intravascular ultrasound guidance enhances the success of PCI procedures by reducing adverse cardiovascular outcomes. In patients presenting with ACS, IVUS-guided stent implantation should be strongly considered as a preferred approach over angiography-guided PCI.
Reference: Li X et al. THE LANCET 2024. Volume 403, Issue 10439, P1855-1865.