Use of imaging guidance during coronary interventions has doubled in recent years
Imaging guidance during percutaneous coronary interventions (PCI) has seen significant growth in recent years, but utilization varies based on geographic region.
Data suggest both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have lower mortality rates following PCI compared to angiography-guided PCI. Although both modalities have seen a rise in utilization, angiography guidance remains the standard of care. The authors of a new paper published in in The American Journal of Cardiology have several explanations as to why this may be the case.
“Potential reasons that make the adoption of ICI even more challenging include clinical inertia, lack of technical training, unfamiliarity with technology, additional instrumentation, complex image interpretation, increased procedure time and radiation, lack of standardized workflow, reimbursement issues, and scarcity of data on its cost-effectiveness and impact on hard clinical endpoints,” Ron Waksman, MD, with the section of interventional cardiology at MedStar Washington Hospital Center, and colleagues explained.
These factors have created barriers to more widespread implementation, but they have not completely inhibited the growth of the modalities. This is especially true in the Western portion of the United States, according to an analysis conducted by Waksman and colleagues.
The group recently reviewed data from patients who underwent PCI between Jan. 1, 2016, and Dec. 31, 2020, throughout the U.S. to determine utilization rates for IVUS and OCT. Their work uncovered widespread variability in provider preference for image guidance during PCI.
Of the nearly 2 million cases included in their review, use of intracoronary imaging (ICI) as a whole nearly doubled, rising from 6.8% to 13.5% over the study period. IVUS increased from 6.5% to 12.9%, while OCT rose from 0.3% to 0.7%, respectively.
Across all four regions, ICI utilization rose substantially, but most notably in the Western region of the U.S., where providers use some form of imaging guidance in 12.6% of PCIs. Midwest and Northeast regions use imaging in 8.9% and 9.9% of PCIs, while Southern regions use it the least, at 7.6%.
Patient factors associated with higher imaging use included Native American race (with reference to Caucasians), COVID-19 infection, complex PCI, high cholesterol, congestive heart failure and prior myocardial infarction, while high volume PCI centers, higher income, private insurance and larger hospital size also played a significant role in imaging choices. In contrast, it was less frequently used in cases of acute coronary syndromes, hypertension and in active smokers in Southern regions.
“This is perhaps due to a lack of definitive guidance on ICI use in acute coronary syndromes in the 2021 American College of Cardiology (ACC) and American Heart Association (AHA) revascularization guidelines,” the group explained. “However, the recent upgrade of ICI to Class 1 recommendation in the latest 2025 ACC/AHA guidelines during management of acute coronary syndrome is a much-needed step to increase the utilization of ICI during PCI.”
The group suggested that support from relevant societies for ICI use will likely continue to grow, improving long-term outcomes for patients.
Learn more about the results here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.