Sociodemographic variation in intracoronary imaging utilization among patients with active malignancy undergoing percutaneous coronary intervention: A National Inpatient Sample analysis.

e13697 Background: Intracoronary imaging–guided percutaneous coronary intervention (PCI) is associated with improved procedural and clinical outcomes compared with angiography-guided PCI. Patients with active malignancy represent a high-risk population; however, data on racial/ethnic, sex, and socioeconomic disparities in intracoronary imaging utilization in this group are limited. Methods: We analyzed the National Inpatient Sample (2016–2021) to evaluate sociodemographic differences in intracoronary imaging utilization among patients with active malignancy undergoing PCI. Active malignancy was defined using ICD-10-CM codes. Intracoronary imaging included intravascular ultrasound (IVUS) and/or optical coherence tomography (OCT). Survey-weighted multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for imaging utilization, adjusting for demographics, clinical presentation, comorbidities, and hospital characteristics. Feature importance was assessed using SHapley Additive exPlanations (SHAP) with gradient boosting models. Results: Among 54,300 weighted hospitalizations for PCI in patients with active malignancy, 6,260 (11.5%) involved intracoronary imaging. Imaging utilization was lower among Black versus White patients (9.1% vs 11.6%), women versus men (9.9% vs 12.2%), and patients in the lowest versus highest income quartile (10.6% vs 14.0%). In adjusted analyses, Black race (aOR 0.81; 95% CI, 0.73–0.90; P < 0.001), Native American race (aOR 0.23; 95% CI, 0.09–0.56; P = 0.001), female sex (aOR 0.83; 95% CI, 0.78–0.88; P < 0.001), and lower income (Q2 vs Q4: aOR 0.77; 95% CI, 0.71–0.84; P < 0.001) were independently associated with lower odds of intracoronary imaging use. SHAP analysis identified geographic region (South: mean |SHAP| = 0.110), STEMI presentation (0.041), and heart failure (0.038) as major predictors of imaging utilization, while female sex (0.032) and lower income (0.026) contributed to reduced imaging probability. Conclusions: Among patients with active malignancy undergoing PCI, substantial sociodemographic disparities exist in intracoronary imaging utilization. Black and Native American patients, women, and individuals with lower income are significantly less likely to receive imaging-guided PCI, despite a threefold increase in overall imaging use during the study period. Targeted strategies are needed to promote equitable access to advanced coronary imaging technologies in this vulnerable population.