What is the clinical evidence from this study?

Study design: Observational. Population: Left main coronary artery disease (n=863). Intervention: Intravascular ultrasound (IVUS) vs. Temporal comparison (2015-2019 vs 2020-2022). Primary outcome: IVUS use in left main PCI over time (p=<0.001).

What question did this study set out to answer?

This research aims to explore the changing use of intravascular ultrasound in left main percutaneous coronary interventions over several years.

April 26, 2026Open Access

B-65 | Evolution of IVUS use in Left Main PCI between 2015-2022

Q: What are the key findings of this study?

IVUS use during left main PCI increased significantly from 16% in 2015-2019 to 38% in 2020-2022 (p<0.001), but remained underutilized overall at 22% across the study period.

Q: What question did this study set out to answer?

This research aims to explore the changing use of intravascular ultrasound in left main percutaneous coronary interventions over several years.

Key Result

IVUS use during left main PCI increased significantly from 16% in 2015-2019 to 38% in 2020-2022 (p<0.001), but remained underutilized overall at 22% across the study period.

Key Points

This research aims to explore the changing use of intravascular ultrasound in left main percutaneous coronary interventions over several years.
Identified left main PCI cases (n=863) from a multicenter cardiac cath lab registry (2015-2022).
Prospectively recorded procedural details and analyzed IVUS use by year.
Compared IVUS use between two time periods: 2015-2019 and 2020-2022.
IVUS utilization during left main PCI increased from 16% (2015-2019) to 38% (2020-2022), p<0.001.
In 2022, IVUS was used in 41.9% of cases, showing a significant growth in adoption.
Despite increased use over time, IVUS remained underutilized relative to recommendations.

Study Design

Type

Observational (n=863)

Multicenter

Yes

Structured PICO

Population

863 left main (LM) PCI cases from a multicenter cardiac cath lab registry (7 participating hospitals) between 2015-2022. Average age 69 years, 66% male.

Intervention

Intravascular ultrasound (IVUS)

Outcome

Evolution of IVUS use according to the year performed

IVUS use during left main PCI has progressively increased over time, reflecting the uptake of clinical guidelines, but it remains underutilized.

Main Result

Absolute Event Rate: 38% vs 16%

p-value: p=<0.001

Abstract

Background: Intravascular ultrasound (IVUS) is an important endovascular imaging tool to guide percutaneous coronary interventions (PCI).Adoption in contemporary PCI practice has been lower than expected despite endorsement in clinical practice guidelines with upgrade of IVUS-guided PCI for left main (LM) disease to 2a recommendation in the 2021 ACC/AHA/SCAI guidelines.We assessed the evolution of IVUS use in LM PCI in a multicenter cardiac cath lab registry over time in relation to changes in clinical practice guidelines.Methods: LM PCI cases (n=863) were identified in the IU Health multicenter cath lab registry which includes 7 participating hospitals between 2015-2022.Procedural details were recorded prospectively for the registry and IVUS use was analyzed according to the year performed.Results: Patients who underwent left main PCI were elderly and had many comorbidities.The average age was 69 years, with 66% male (n=568) and 34% being female (n=295).IVUS was used in 195 of cases (22%).The use of IVUS increased progressively over time (see Figure 1) with the most frequent use of IVUS in the last year of the registry (2022) when it was used in 41.9% of cases (n=39).IVUS use was higher in 2020-2022 compared to 2015-2019 (38% vs 16%; p<0.001).Conclusions: Overall, IVUS use during LM PCI increased over time reflecting uptake of clinical trials evidence and clinical guideline recommendation in contemporary practice but remained underutilized.

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