Coronary disease & ACSCohort study
Intravascular imaging during percutaneous coronary intervention: temporal trends and clinical outcomes in the USA
- Retrospective cohort study
- Medicare beneficiaries
- multivariable Cox regression
- falsification endpoints
Authors' conclusion
Among Medicare beneficiaries undergoing PCI, use of IVI has increased over the previous decade but remains relatively infrequent. IVI-guided PCI was associated with lower risk-adjusted mortality, acute MI, repeat PCI, and MACE.
Study context
- Population
- Medicare beneficiaries undergoing percutaneous coronary intervention (PCI), inpatient and outpatient, USA, 2013–2019
- Participants
- 1,189,470 beneficiaries
- Exposure
- Intravascular imaging (IVI)-guided PCI vs PCI with angiography guidance alone
- Outcome
- Mortality and MACE (death, myocardial infarction (MI), repeat PCI or CABG)
- Follow-up
- 1 year
Main finding
As reported in the abstract
IVI vs AngiographyAdjusted hazard ratio (95% CI)
mortality
0.96(0.94–0.98)
MACE
0.85(0.84–0.86)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (95% CI) | |
|---|---|---|
| MI · 1 year · multivariable Cox regression | 0.97 (0.95–0.99) | |
| Repeat PCI · 1 year · multivariable Cox regression | 0.74 (0.73–0.75) | |
| 0.512Adjusted hazard ratio (log scale) |
IVI use during PCI (temporal trend and operator variation)
- IVI used overall
- 10.5%
- IVI use in 2013
- 9.5%
- IVI use in 2019
- 15.4%
- Median operator IVI use (IQR 0.36%-12.82%)
- 3.92%
Falsification endpoints (hospitalized pneumonia, hip fracture)
- No association with hospitalized pneumonia
- aHR 1.02, 95% CI 0.99-1.04
- No association with hip fracture
- aHR 1.02, 95% CI 0.94-1.10
- used to assess for potential unmeasured confounding
Original publication
Intravascular imaging during percutaneous coronary intervention: temporal trends and clinical outcomes in the USA. Eur Heart J. Published 20 July 2023. doi:10.1093/eurheartj/ehad430
Summarised from the published abstract; every number is checked against it