B-66 | Outcomes of Physiology-Guided Percutaneous Coronary Intervention in Frail Patients

Background: Intravascular ultrasound (IVUS) is an important endovascular imaging tool to guide percutaneous coronary interventions (PCI).Adoption in contemporary PCI practice has been lower than expected despite endorsement in clinical practice guidelines with upgrade of IVUS-guided PCI for left main (LM) disease to 2a recommendation in the 2021 ACC/AHA/SCAI guidelines.We assessed the evolution of IVUS use in LM PCI in a multicenter cardiac cath lab registry over time in relation to changes in clinical practice guidelines.Methods: LM PCI cases (n=863) were identified in the IU Health multicenter cath lab registry which includes 7 participating hospitals between 2015-2022.Procedural details were recorded prospectively for the registry and IVUS use was analyzed according to the year performed.Results: Patients who underwent left main PCI were elderly and had many comorbidities.The average age was 69 years, with 66% male (n=568) and 34% being female (n=295).IVUS was used in 195 of cases (22%).The use of IVUS increased progressively over time (see Figure 1) with the most frequent use of IVUS in the last year of the registry (2022) when it was used in 41.9% of cases (n=39).IVUS use was higher in 2020-2022 compared to 2015-2019 (38% vs 16%; p<0.001).Conclusions: Overall, IVUS use during LM PCI increased over time reflecting uptake of clinical trials evidence and clinical guideline recommendation in contemporary practice but remained underutilized.