Intravascular imaging in patients with acute coronary syndromes: insights from the EuroHeart ACS-PCI registry collaboration

Background Intravascular imaging (IVI) is a well-established tool to guide and optimize percutaneous coronary interventions in acute coronary syndrome (ACS) patients, resulting in reduction of major adverse cardiovascular events. It is also useful in ACS patients without angiographically significant coronary artery disease, or with ambiguous or multiple culprit lesions. Thus, usage of IVI is strongly recommended by the current ESC guidelines. However, data regarding its adoption in daily practice is still needed. Purpose To assess usage of IVI in patients with ACS across 7 countries contributing to the EuroHeart ACS-PCI registry, and to identify disparities between different patient categories. Methods We assessed use of IVI in the EuroHeart ACS-PCI registry collaboration database, collected in 2024 from participating centres from 7 countries, which recorded consecutive admissions of patients with ACS. Data were stratified by country, according to the final diagnosis of ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI), IVI method used – ultrasound (IVUS) or optical coherence tomography (OCT), and characteristics of age (divided by 10-year bands: <60, 60-69, 70-79 and >80 years), sex, and diabetes. All analyses are descriptive. Results Data from a total of 102,926 admissions were collected (STEMI: 41.7% and NSTEMI: 58.3%). NSTEMI patients were older (mean average age 68.4 vs 65.4 years) and more frequently had diabetes (34.8% vs 23.3%). In STEMI, IVUS was used in 8.4% of cases, but with significant variations between countries (lowest and highest individual country mean: 0.3 – 16.4%), while OCT was used in only 1.7% of cases, with the same disparities between countries (0.0 – 7.4%). For both methods, there were no disparities driven by sex or presence of diabetes across countries. There was less usage of imaging for elderly patients, except for IVUS. In NSTEMI, both methods were more frequently used, but with persistent country variations: overall mean use of IVUS was 12.4% (0.8 – 26.7%) and 2.7% for OCT (0.0 – 8.8%). There were no disparities driven by sex or presence of diabetes across countries. When stratified by age, IVUS did not show significant disparities between age groups, while OCT was less frequently used in elderly patients. Conclusions In our analysis of more than 100,000 patients enrolled in the EuroHeart ACS-PCI registry collaboration, usage of IVI remains generally low across contributing countries but with important national differences. While use of these methods is homogenous when reporting to sex and diabetic status, age stratification reveals less use in the elderly patients.NSTEMISTEMI