Rates of Intracoronary Imaging Optimization in Contemporary Percutaneous Coronary Intervention: A Report From the BMC2 Registry

Abstract

Background: Intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) improves outcomes, yet hospital- and physician-level variabilities in ICI and its impact on ICI use in contemporary PCI remain unknown. This study was performed to evaluate hospital- and physician-level use of ICI to optimize PCI. Methods: Using data from a large statewide registry, patients undergoing PCI between July 2019 and March 2021 were studied. The primary measure of interest was ICI (intravascular ultrasound or optical coherence tomography) optimization during PCI. A fitted hierarchical Bayesian model identified variables independently associated with ICI optimization. The performing hospital and physician were included as random effects in the model. Results: Among 48 872 PCIs, ICI optimization was performed in 8094 (16.6%). Median [interquartile range] hospital- and physician-level frequencies of ICI were 8.8% [3.1%, 16.0%] and 6.1% [1.1%, 25.0%], respectively. Bayesian modeling identified left main PCI (adjusted odds ratio [aOR], 4.41; 95% credible interval [3.82, 5.10]), proximal left anterior descending artery PCI (aOR, 2.28 [2.00, 2.59]), PCI for in-stent restenosis (aOR, 1.55 [1.40, 1.72]), and surgical consult prior to PCI (aOR, 1.21 [1.07, 1.37]) as independent predictors of ICI optimization. The hospital-level median odds ratio, an estimate of the contribution of inter-hospital variability in odds of ICI use, was 3.48 (2.64, 5.04). Physician-level median odds ratio was 3.81 (3.33, 4.45). Conclusions: Substantial hospital- and physician-level variation in ICI was observed. Except for performance of left main PCI, the hospital and physician performing the PCI were more strongly associated with ICI optimization than any patient or procedural factors.

Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis

“…A nationwide US study showed that use of intravascular imaging was below 5% between 2004 and 2014 45. A large state registry in Michigan showed that only 5.6% of all percutaneous coronary interventions in Medicare patients were done with intravascular ultrasonography 46. The results of this meta-analysis should encourage wider adoption of intravascular imaging guided percutaneous coronary intervention in clinical practice.…”

Intravascular Imaging Use by Intermediate to High-Volume US Operators – A Medicare Data Analysis

“…A recent study noted that operator variability was an even stronger predictor for IVI use than any patient or procedural characteristic. 3 To our knowledge, this is the first study associating specific physician characteristics with IVI use.…”

“…Despite randomized trials 1 showing reduced target vessel failure and major adverse cardiovascular events with intravascular imaging (IVI) guided percutaneous coronary intervention (PCI), IVI is used in only 7.8% of all PCI in the United States. 2 , 3 Operator variation in IVI use and characteristics of operators with low IVI use have not been previously studied.…”

Intravascular Imaging for Guiding Percutaneous Coronary Intervention: What Does the Totality of Data Suggest, and Where Should We Go?

“…Although use of intravascular imaging in the United States between 2004 and 2017 was 5% to 6%, it has since increased. 10 At 48 hospitals participating in the State of Michigan the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, the use of intravascular imaging for PCI guidance increased from 7.2% to 22.6% between July 2019 and March 2021. The authors speculate that reasons underlying this increase are more evidence of clinical benefits of intravascular imaging, and an emphasis on quality at the quarterly registry meetings.…”