Angiography alone versus angiography plus intracoronary imaging to guide emergency percutaneous coronary intervention: outcomes from a single-centre retrospective analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background There is emerging evidence showing improvement in clinical outcomes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS)-guided elective percutaneous coronary intervention (PCI). Yet data supporting their use emergency setting are still conflicting. Purpose We aim to compare the immediate angiographic outcomes, short long-term patients undergoing PCI intracoronary imaging those angiography guidance only. Methods included 426 from May 2012 December 2020 who presented ST-elevation myocardial infarction (STEMI) underwent within 24 hours hospital admission. Intracoronary was used 196 them guide PCI. Immediate terms TIMI flow grade (TFG), blush (MBG) corrected frame count (CTFC) compared. Clinical including major adverse cardiac events (MACE), target vessel revascularization (TVR), hospitalization for heart failure all-cause mortality were also Results (46%) imaging-guided Use associated a higher post procedural CTFC (27.0 vs. 25.8, p=0.11), yet it failed reach statistical significance. Comparing angiography-guided PCI, significantly larger proportion high procedure (slow flow) (OR, 0.62; 95% CI: 0.38-1.0, P=0.05), this result consistent after adjustment variables (adjusted OR, 0.57; CI 0.34-0.98, P=0.04). Subjective measures MBG, however, not different between 2 groups. In subgroup Syntax score American Heart Association (AHA)/American College Cardiology (ACC) type C culprit lesion morphology, guided worse MBG 0.36; 0.17-0.78, P=0.01 0.40; 0.18-0.94, P=0.04), results adjusting variables. score, 0.35; 0.12-0.95, P=0.05) trend towards 0.26; 0.06-0.94, The cumulative incidences all outcome groups before confounders. Conclusions Imaging-guided improved or STEMI may associate outcomes.