Background. Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk of clinical events in patients with acute coronary syndromes (ACS), compared with angiography guidance. However, the benefits of IVUS guidance in high-risk diabetic patients with ACS is uncertain.

Objectives. This pre-specified stratified subgroup analysis from the IVUS-ACS randomized trial aims to determine the effectiveness of IVUS-guided PCI vs. angiography-guided PCI in diabetic patients with ACS.

Methods. From August 20, 2019, to October 27, 2022, 1105 diabetic patients with ACS were randomized, including 554 patients in the IVUS-guided group and 551 in the angiography-guided group. The primary endpoint was the rate of target vessel failure (TVF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction, or clinically-driven target vessel revascularization (TVR).

Results. At 1-year follow-up, TVF occurred in 20 patients in the IVUS guidance group and in 46 patients in the angiography guidance group (Kaplan-Meier rates, 3.6% vs. 8.3%; HR, 0.46; 95% CI, 0.27 to 0.81; P=0.007), driven by a reduction in clinically-driven TVR (0.9% vs. 3.8%, P=0.003). IVUS-guided PCI also reduced the risk of TVF without procedural myocardial infarction (2.0% vs. 6.7%; HR, 0.29; 95% CI, 0.15 to 0.57; P < 0.001) and all-cause mortality (HR, 0.30; 95% CI, 0.10 to 0.93; P=0.037). There were no significant differences in the rates of stent thrombosis or major bleeding between the groups.

Conclusions. In the large-scale IVUS-ACS trial, IVUS-guided PCI improved 1-year clinical outcomes in high-risk diabetic patients with ACS.

Editors

JACC: Cardiovascular Interventions Editor-in-Chief
David J. Moliterno, MD, FACC

JACC: Cardiovascular Interventions CME/MOC Editor
Michael C. McDaniel, MD

Author

Shao-Liang Chen, MD


Important Dates

Date of Release: February 10, 2025
Term of Approval/Date of CME/MOC Expiration: February 9, 2026