Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions | 2021
National trends of utilization and readmission rates with intravascular ultrasound use for ST-elevation myocardial infarction.
Abstract
BACKGROUND\nRandomized trials have confirmed that intravascular ultrasound (IVUS) guidance for percutaneous coronary interventions (PCI) improves long-term clinical outcomes. However, data on real-world utilization of IVUS in ST-elevation myocardial infarction (STEMI) and the impact on short to mid-term outcomes are scarce. We sought to evaluate the utilization and the readmission rates for IVUS-guided PCI in the setting of STEMI.\n\n\nMETHODS\nHospitalizations with a primary diagnosis of STEMI undergoing PCI were included from the Nationwide Readmissions Database (NRD) during 2012-2017.\n\n\nRESULTS\nAmong 809,601 hospitalizations with STEMI undergoing PCI, 33,644 (4.2%) underwent IVUS-guided PCI. IVUS use increased from 4.2% in 2012 to 5.6% in 2017 (p\u2009<\u2009.0001). After matching, in-hospital mortality was significantly lower with IVUS use (3.9% vs. 4.6%, p\u2009<\u2009.0001). The overall readmission rates were similar in both groups. We found that readmission rates due to acute MI at 6 months (5.7% vs. 6%, p = .045) and 11\u2009months (5.1% vs. 6.5%, p = 0.005) as well as the PCI and mortality rates during readmission at 11\u2009months (2.1% vs. 3%, p = .008, and 0.7% vs. 1.4%, p = .002, respectively) were significantly lower in the IVUS group.\n\n\nCONCLUSIONS\nThe utilization of IVUS in STEMI appears to be slowly increasing. Although overall readmission rates were similar, IVUS was associated with lower in-hospital mortality, lower rates of readmission due to acute MI at 6 and 11\u2009months, as well as lower PCI and mortality at 11\u2009months. Randomized trials evaluating long-term benefits of IVUS in STEMI are needed.