摘要Background The intravascular ultrasound(IVUS)-guided percutaneous coronary intervention(PCI)can bene-fit the treatment of coronary artery disease(CAD).However,the beneficial effect of IVUS-guided PCI in patients with acute myocardial infarction(AMI)remains controversial.Methods Atotal of 537 AMI patients were included in this study,divided into two groups:the angiography-guided group(n=289)and the IVUS-guided group(n=248)according to whether the IVUS was applied.The primary outcome was a composite of major adverse cardiovascu-lar events(MACEs),including cardiovascular death,recurrent myocardial infarction(MI),and target lesion revas-cularization(TLR).The secondary outcome was procedural radiation exposure time.Results The IVUS-guided group was associated with a reduced incidence of MACEs(12.8％vs.8.5％,P=0.032).The results were consistent after adjusting for confounders in the multivariable Cox analysis,which showed that the absence of IVUS(HR 1.194,95％CI 1.061-1.323,P=0.011)was an independent predictor of MACEs.Additionally,the IVUS-guided group experienced significantly lower float time(893.3±265.2 min vs.623.2±137.3 min,P＜0.001).Conclusions The use of IVUS was associated with better long-term cardiovascular outcomes.The use of IVUS in PCI should be considered for patients with AMI to optimize procedural outcomes and enhance long-term prognosis.