Intravascular imaging use during PCI increased from 12.3% to 43.1% between 2010 and 2022, but was not associated with statistically significant differences in 1-year mortality or MACE.
Cohort (n=136,071)
Yes
Does intravascular imaging during PCI improve 1-year mortality or major adverse cardiovascular events in patients undergoing PCI at Veterans Affairs hospitals?
Intravascular imaging during PCI is increasing and serves as a highly reliable performance measure at the hospital and physician levels, though it was not associated with improved 1-year clinical outcomes in this VA cohort.
BACKGROUND: Intravascular imaging (IVI) is widely recognized to improve outcomes after percutaneous coronary intervention (PCI). However, IVI is underutilized and is not yet established as a performance measure for quality PCI. METHODS: We examined temporal trends of IVI use for all PCIs performed at Veterans Affairs hospitals in the United States from 2010 to 2022 using retrospective observational cohorts. IVI was defined as intravascular ultrasound or optical coherence tomography. A contemporary subset of PCIs from 2020 to 2022 was used to examine clinical characteristics associated with IVI use and test the reliability of IVI as a pass/fail performance measure. We then used a generalized linear mixed model to estimate the proportion of IVI use variability attributable to the hospital, physician, and patient level. Cox proportional hazard models were used to assess the association of IVI with clinical outcomes at 1 year. RESULTS: IVI use increased from 12.3% in 2010 to 43.1% in 2022 in 136 071 PCIs included in the study. Among 22 918 PCIs in the contemporary cohort, IVI was more frequent with nonemergent presentations, chronic total occlusions, and left main lesions but usage variability was primarily attributable to hospital (54%) and physician (33%) levels. As a pass/fail performance measure, reliability was high (>0.96) at hospital and physician levels. However, IVI use was not associated with statistically significant differences in mortality or major adverse cardiovascular events in this cohort. CONCLUSIONS: IVI use for PCI is increasing rapidly at Veterans Affairs hospitals in the United States but with marked variation at the hospital and physician levels. IVI meets established criteria for an effective performance measure and should be measured and reported by local and national organizations to encourage further uptake. Ongoing training and quality improvement may be required to maximize the benefit of IVI as it is more widely utilized.
Stein et al. (Fri,) conducted a cohort in Percutaneous coronary intervention (PCI) (n=136,071). Intravascular imaging (IVI) vs. No intravascular imaging was evaluated on Mortality or major adverse cardiovascular events at 1 year. Intravascular imaging use during PCI increased from 12.3% to 43.1% between 2010 and 2022, but was not associated with statistically significant differences in 1-year mortality or MACE.