Current perspectives on the use of intracoronary imaging in interventional practice in the Asia-Pacific

The perceptions of the Asia-Pacific interventional community towards intracoronary imaging (ICI) has not been systematically evaluated. This study aimed to evaluate adoption rates, operator perceptions, and attitudes towards ICI amongst the cardiology community in the Asia-Pacific. A web-based survey was conducted from April to September 2025 among cardiologists performing percutaneous coronary intervention from the Asia-Pacific region. Demographic characteristics as well as the availability, frequency of use, and perceptions of ICI were assessed. Among 672 survey responses, 71.4% of respondents were from high-income countries. ICI was available in 93.5% of institutions; however, availability of ICI was lower in low- and middle-income countries (85.3% vs. 96.7%, p < 0.001). Personal experience with intravascular ultrasound was reported by most respondents (93.7%), while 67.7% had experience with optical coherence tomography. Majority of respondents (93.5%) believed that ICI improves clinical outcomes compared with angiography. Cost-effectiveness of ICI was perceived as good by 48.5% of respondents, average by 38.7%, and poor by 10.3%. Major reasons limiting the clinical use of ICI were high cost (56.8%), regulatory/reimbursement issues (42.1%), and prolongation of diagnostic procedure (36.5%). In a cohort consisting predominantly of interventional cardiologists from high-income countries, substantial variability in practice patterns and perceptions were observed according to region. These findings highlight the need for targeted strategies to address the practice gaps within the Asia-Pacific interventional community.