Intravascular Ultrasound-Guided versus Angiography-Guided PCI in Patients with Diabetes with Acute Coronary Syndromes: The IVUS ACS Trial (JACC Cardiovascular Interventions February 2025)-Article: travascular Ultrasound-Guided versus Angiography-Guided PCI in Patients with Diabetes with Acute Coronary Syndromes: The IVUS ACS Trial

Article: travascular Ultrasound-Guided versus Angiography-Guided PCI in Patients with Diabetes with Acute Coronary Syndromes: The IVUS ACS Trial

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The IVUS-ACS trial investigated the effectiveness of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) versus traditional angiography-guided PCI in high-risk patients with diabetes presenting with acute coronary syndromes (ACS). Conducted across four countries (China, Italy, Pakistan, UK) from August 2019 to October 2022, the trial randomized 1,105 diabetic patients into IVUS-guided (n=554) and angiography-guided groups (n=551), examining clinical outcomes at 1-year follow-up. The primary endpoint was target vessel failure (TVF), which includes cardiac death, myocardial infarction, or target vessel revascularization.<br /><br />Results demonstrated a significant reduction in the 1-year TVF rate in the IVUS-guided group (3.6%) compared to the angiographic group (8.3%), driven predominantly by fewer revascularizations. IVUS guidance also reduced the risk of TVF without procedural myocardial infarction (2.0% vs. 6.7%) and all-cause mortality (0.7% vs. 2.4%). However, no significant differences were observed in stent thrombosis or major bleeding rates between the groups.<br /><br />The study highlights that IVUS-guided PCI leads to more stents being used, with larger diameters and lengths, alongside more frequent postdilation, resulting in higher procedural success and improved clinical outcomes, particularly when optimal IVUS criteria for stent implantation were achieved. The trial's insights emphasize the benefit of IVUS, especially in diabetic patients, suggesting less frequent revascularization and lower mortality rates with IVUS guidance.<br /><br />Although limitations existed, including power constraints for subgroups and geographic enrollment bias, the study strongly supports the utility of IVUS-guidance in improving outcomes for diabetic ACS patients, warranting consideration in clinical practice. The trial was well-supported by multiple international organizations and complies with ethical standards, confirming the robustness of its findings.

Keywords

IVUS-ACS trial

intravascular ultrasound

percutaneous coronary intervention

angiography-guided PCI

diabetic patients

acute coronary syndromes

target vessel failure

clinical outcomes

revascularization

mortality rates