National trends and in-hospital outcomes of intracoronary imaging during percutaneous coronary intervention in patients with active malignancy: A National Inpatient Sample analysis.

e13700 Background: Intracoronary imaging–guided percutaneous coronary intervention (PCI) improves procedural outcomes in the general population. However, utilization patterns and in-hospital safety of intracoronary imaging in patients with active malignancy (a high-risk population with competing mortality and unique physiologic considerations) are not well defined. Methods: We analyzed the National Inpatient Sample (2016–2021) to identify hospitalizations of adults with active malignancy (ICD-10-CM) undergoing PCI. Temporal trends in intracoronary imaging use (intravascular ultrasound and/or optical coherence tomography) were assessed. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury, major bleeding, blood transfusion, stroke, vascular complications, mechanical ventilation, length of stay, and total hospital charges. Survey-weighted multivariable regression was used to estimate adjusted odds ratios (aORs), adjusting for demographics, clinical presentation, comorbidities, and hospital characteristics. Results: Among 54,300 weighted hospitalizations, intracoronary imaging utilization increased from 6.1% in 2016 to 18.1% in 2021 (r = 0.974; P = .001). Imaging use was not associated with in-hospital mortality (5.4% vs 5.5%; aOR, 0.92; 95% CI, 0.80–1.05; P = .214). There were no significant differences in acute kidney injury (aOR, 1.06; P = .101), major bleeding (aOR, 1.04; P = .412), or stroke (aOR, 1.04; P = .670). However, imaging was associated with higher odds of vascular complications (aOR, 1.82; 95% CI, 1.24–2.65; P = .002), mechanical ventilation (aOR, 1.15; 95% CI, 1.03–1.30; P = .016), and blood transfusion (aOR, 1.44; 95% CI, 1.30–1.58; P < .001). Imaging was also associated with longer length of stay (+0.46 days; P = .019) and higher hospital charges (+$23,324; P < .001). Conclusions: Use of intracoronary imaging during PCI among patients with active malignancy has increased nearly threefold over six years. Imaging was not associated with higher in-hospital mortality or major complications, including acute kidney injury, bleeding, or stroke. Associations with vascular complications and increased resource utilization likely reflect greater case complexity rather than imaging-related harm. These findings support the procedural safety of intracoronary imaging in this high-risk population.