Adjunctive Imaging and Physiology During Percutaneous Coronary Intervention: Trends, Outcomes, and Costs Among Medicare Beneficiaries.

BACKGROUND: The dual use of intravascular imaging (IVI) and invasive physiology (IP) during percutaneous coronary intervention (PCI) is not well described in the United States.

OBJECTIVES: The aim of this study was to measure trends, clinical outcomes, and costs associated with the use of IVI and IP, alone and together, during PCI.

METHODS: Medicare fee-for-service claims were used to analyze trends in the use of IVI and/or IP during PCI from 2016 to 2023. Beneficiaries ≥65 years of age with a first PCI during the study period were included in the outcomes analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, repeat revascularization, and all-cause death at 2 years. Multivariable Cox proportional regression was used to assess outcomes. Gamma regression was used to assess costs.

RESULTS: A total of 2,538,154 PCIs were performed in 1,958,990 patients from 2016 to 2023. After exclusion, a total of 1,587,532 patients were included in the analysis. Overall, IVI was used in about 15%, IP in 7%, and dual IVI and IP in 2.5% of all PCIs. By 2023, the use of IVI and dual IVI and IP increased to about 30% and 4.7%, respectively. Dual IVI and IP was associated with lower rates of MACE at 2 years compared with angiography alone (adjusted HR: 0.87; 95% CI: 0.85-0.89; P < 0.0001). The cost analysis showed higher upfront procedural costs but lower long-term costs associated with any use of IVI and/or IP.

CONCLUSIONS: The dual use of IVI and IP has marginally increased and was associated with lower MACE and long-term costs compared with angiography alone.