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.