Adoption of intravascular imaging-guided percutaneous coronary intervention in the United States (2012–2022): temporal trends, disparities, and mortality association

Background Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI), using intravascular ultrasound (IVUS) or optical coherence tomography (OCT), improves clinical outcomes. Contemporary data on US adoption trends, demographic, and hospital disparities remain limited. Methods and results We analyzed 5,220,590 PCI admissions from the National Inpatient Sample (2012–2022). IVI use was defined by concurrent procedural codes for IVUS or OCT. Outcomes included temporal trends, in-hospital mortality, resource utilization, and disparities. Given the large sample size, standardized mean differences (SMDs) were reported to quantify between-group differences, with an absolute SMD of >0.10 indicating a meaningful imbalance. Multivariable logistic regression was adjusted for demographics, comorbidities, and hospital characteristics. To further address potential confounding by indication, propensity score matching was performed. Patients were matched 1:1 using nearest-neighbor matching without replacement, with a caliper of 0.2 standard deviations of the propensity score and exact matching on calendar year. Covariate balance before and after matching was assessed using absolute SMDs, with an absolute SMD <0.10 indicating an adequate balance. IVI-guided PCI increased from 7.1% (2012) to 21.3% (2022) ( p trend < 0.001). Minimal demographic disparities existed, but significant hospital-level variations were observed; hospitals in the Northeast had the highest adoption (27.6% in 2022 vs. 16.3% in Western hospitals). In-hospital mortality occurred in 2.32% of IVI hospitalizations compared with 2.88% of hospitalizations without IVI guidance. After adjusting for demographic characteristics, acute clinical presentation and severity—including STEMI, NSTEMI, cardiogenic shock, and cardiac arrest—comorbidities, payer, hospital characteristics, and calendar year, IVI remained significantly associated with lower odds of in-hospital mortality (aOR 0.783, 95% CI 0.742–0.827; P < 0.001), higher routine discharge rates (84.1% vs. 83.7%; p < 0.001), longer median length-of-stay (3 days [interquartile range (IQR) 2–5] vs. 2 days [IQR 2–4]; p < 0.001), and increased costs [$25,144 (IQR $18,749–$36,439) vs. $20,165 (IQR $15,293–$28,381); p < 0.001]. Conclusion While IVI-guided PCI adoption increased significantly, pronounced hospital-level disparities exist. Targeted efforts to enhance adoption—particularly in rural, non-teaching hospitals and low-utilization regions—are needed.