Adopting an intravascular imaging-guided management strategy for patients presenting with acute coronary syndrome: from understanding the mechanism to treatment optimisation

Japan is uniquely positioned in contemporary percutaneous coronary intervention (PCI); few countries have integrated intravascular imaging (IVI) into routine practice as consistently – or as broadly across clinical presentations – as Japan. The “near-default” use of intravascular ultrasound (IVUS) and the growing penetration of optical coherence tomography (OCT) create an opportunity to study imaging guidance when it is woven into routine PCI decision-making.

In this issue of EuroIntervention, Takegawa and colleagues used the National Database of Health Insurance Claims and Specific Health Checkups of Japan – an administrative dataset with anonymised patient-level information on diagnoses, procedures, prescriptions, and medical devices across inpatient and outpatient care – to evaluate the association between IVI-guided PCI and outcomes in patients presenting with acute coronary syndrome (ACS), approximately two-thirds of whom had acute myocardial infarction (AMI)1. A patient-matching approach enabled the long-term follow-up of more than 90% of patients.

Between April 2014 and March 2021, 492,303 ACS patients underwent their first PCI. Over that period, OCT-guided PCI increased from 4.7% to 6.9%, IVUS-guided PCI increased from 77.0% to 87.9%, and angiography-guided PCI alone decreased from...