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Impact and trends of intravascular imaging in diagnostic coronary angiography and percutaneous coronary intervention in inpatients in the United States
Author(s) -
Smilowitz Nathaniel R.,
Mohananey Divyanshu,
Razzouk Louai,
Weisz Giora,
Slater James N.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27673
Subject(s) - medicine , intravascular ultrasound , percutaneous coronary intervention , conventional pci , cardiac catheterization , radiology , angiography , coronary angiography , cardiology , cardiac imaging , myocardial infarction
Background Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is an important adjunct to invasive coronary angiography. Objectives The primary objective was to examine the frequency of intravascular coronary imaging, trends in imaging use, and outcomes of patients undergoing angiography and/or percutaneous coronary intervention (PCI) in the United States. Methods Adult patients ≥18 years of age undergoing in‐hospital cardiac catheterization from January 2004 to December 2014 were identified from the National Inpatient Sample (NIS). International Classification of Diseases, Ninth Revision (ICD‐9) diagnosis and procedure codes were used to identify IVUS and OCT use during diagnostic angiography and PCI. Results Among 3,211,872 hospitalizations with coronary angiography, intracoronary imaging was performed in 88,775 cases (4.8% of PCI and 1.0% of diagnostic procedures), with IVUS in 98.9% and OCT in 1.1% of cases. Among patients undergoing PCI, the rate of intravascular coronary imaging increased from 2.1% in 2004–2005 to 6.6% in 2013–2014 ( P < 0.001 for trend). Use of intravascular coronary imaging was associated with lower in‐hospital mortality in patients undergoing PCI (adjusted OR 0.77; 95% CI 0.71–0.83). There was marked variability in intravascular imaging by hospital, with 63% and 13% of facilities using intravascular imaging in <5% and >15% of PCIs, respectively. Conclusions In a large administrative database from the United States, intravascular imaging use was low, increased over time, and imaging was associated with reduced in‐hospital mortality. Substantial variation in the frequency of intravascular imaging by hospital was observed. Additional investigation to determine clinical benefits of IVUS and OCT are warranted.