C-16 | Intravascular Ultrasound in Percutaneous Coronary Interventions: A Nationwide Overview of its Use and Outcomes

Intravascular ultrasound (IVUS) is a valuable adjunct to angiography, aiding interventionists in evaluating lesion severity, plaque morphology, stent apposition, stent expansion, and edge dissection. IVUS-guided PCI may increase procedure time but can lead to increased stent patency rates. This study aims to provide insights into the comparative outcomes of IVUS and non-IVUS-guided PCI in real-world clinical settings. We compared outcome measures with the 2020 United States National Inpatient Sample in patients who received IVUS-guided PCI and those who did not. The primary outcome was the mortality rate between the two groups. IVUS was used in 10,757 of the 86,844 patients (12.4%) with a PCI. The mean age was similar in those with IVUS-guided PCI and those without (65.5 years vs. 65.6 years, p = 0.58). The mean length of stay was slightly higher in the IVUS group than in the non-IVUS group (4.3 vs. 3.9 days, p<0.001). IVUS was more likely to be used in urban teaching hospitals at 12.9% than in rural hospitals at 10%, p<0.001. IVUS was most used in the West and Northeast regions of the United States at 17.8% and 17.2%, respectively, and less in the Midwest at 13.1% and South at 9.5%, p<0.001. IVUS was more likely to be used in large-sized hospitals at 14.1% compared to medium-sized hospitals at 10.6% and small-sized hospitals at 10.1%, p<0.001. IVUS was used less in patients who had an ST elevated myocardial infarction (STEMI) than those who did not, 10.7% vs. 13%, p<0.001. In the multivariate analysis, IVUS use was associated with decreased inpatient mortality (OR 0.86, 95% CI 0.76-0.97, p = 0.015), even after adjusting for baseline characteristics. IVUS was used less during a STEMI and was associated with a decreased inpatient mortality. IVUS guided-PCI is highest in large and urban-sized hospitals and hospitals in the West and Northeast regions of the United States.