Association of increased coronary physiology and intracoronary imaging use with downstream healthcare costs.

BACKGROUND

Invasive coronary physiology and intracoronary imaging improve coronary lesion assessment and percutaneous coronary intervention optimization, but their financial implications in routine community-based practice remain incompletely defined. We evaluated the association between increased use of coronary physiology/imaging-guided assessment and downstream healthcare costs.

METHODS

We conducted a retrospective observational analysis of patients undergoing invasive coronary angiography within the HonorHealth health system between January 1, 2021 and December 31, 2022. The year 2021 represented baseline practice, whereas 2022 followed implementation of an institutional initiative encouraging physiologic assessment or intracoronary imaging during coronary angiography and PCI. Procedures were categorized as diagnostic left heart catheterization alone, physiologic testing without PCI, physiologic testing with PCI, or PCI without physiologic testing. Mean healthcare costs were compared at 30 days, 90 days, and 6 months after the index procedure.

RESULTS

A total of 1807 diagnostic coronary angiograms were performed in 2021 and 1821 in 2022, with similar PCI volumes. Use of physiologic assessment increased from 44.4% to 51.0% after implementation (p < 0.001). Although 30-day costs were higher for procedures involving physiologic testing in 2022, mean 6-month costs were lower across all procedural categories. Estimated cumulative 6-month cost reductions totaled $1,661,504.

CONCLUSIONS

In this retrospective health-system analysis, increased use of invasive coronary physiology and intracoronary imaging was associated with lower cumulative 6-month healthcare costs despite higher short-term procedural expenses. Further multicenter studies with longer follow-up are warranted.