Multimodality Intravascular Imaging Guidance (NIRS-IVUS-OCT) Compared to Angiography-Guided Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: the NIRVUS Trial

BACKGROUND: Imaging‐guided percutaneous coronary intervention (PCI) improves outcomes, but the clinical utility of near‐infrared spectroscopy (NIRS) remains unclear. AIMS: The aim of the study was to evaluate whether multimodality imaging with NIRS, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) would improve stent strut coverage compared with angiography‐guided PCI in patients with acute myocardial infarction (MI) and further to assess the impact of lipid‐rich plaque (LRP) on vascular healing. METHODS: A total of 104 patients with MI were randomized to imaging‐ or angiography‐guided PCI. NIRS‐IVUS imaging was performed pre‐ and post‐PCI, and OCT post‐PCI and at 6‐month follow‐up. Maximum lipid core burden index in a 4‐mm segment (maxLCBI4 mm) was measured. The primary endpoint was percentage of covered stent struts (OCT) at 6‐month follow‐up. RESULTS: Pre‐PCI maxLCBI4 mm was similar in the two groups (441 [239, 565] vs. 333 [242, 517], p = 0.19). Imaging guidance resulted in a larger minimal stent area (7.3 ± 2.4 mm2 vs. 6.5 ± 1.7 mm2, p = 0.04). At 6‐month follow‐up, stent strut coverage was higher in the imaging group (86.9% [77.7, 93.7] vs. 74.4% [53.8, 81.8], p < 0.001). Segment‐level analyses showed that LRP without superficial attenuation and suboptimal stent expansion was associated with higher percentage of intima hyperplasia (23.4% [20.5, 25.9] vs. 13.9% [10.6, 16.0], p < 0.001) compared to optimal stent expansion, whereas LRP with attenuation and suboptimal stent expansion was associated with higher rates of late‐acquired stent malapposition (81.8% vs. 30.0%, p = 0.02) compared to optimal stent expansion. CONCLUSION: Imaging‐guided PCI improved stent strut coverage. LRP phenotypes were associated with different healing patterns. CLINICAL TRIAL REGISTRATION INFORMATION: Clinical Trial Registration Information: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04460482.