Intravascular Imaging as a Performance Measure for Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Health Services Research

Background:

• Intravascular imaging (IVI) improves percutaneous coronary intervention (PCI) outcomes but remains underutilized.
• Current quality metrics do not consistently incorporate IVI, hindering its widespread adoption.

Purpose of the Study:

• To analyze temporal trends in IVI utilization for PCI within Veterans Affairs (VA) hospitals.
• To assess factors influencing IVI use and its reliability as a performance measure.
• To evaluate the association of IVI use with clinical outcomes post-PCI.

Main Methods:

• Retrospective analysis of 136,071 PCIs from VA hospitals (2010-2022).
• Contemporary cohort (2020-2022) examined for IVI use predictors and performance measure reliability.
• Statistical models assessed variability sources (hospital, physician, patient) and 1-year clinical outcomes.

Main Results:

• IVI use increased from 12.3% to 43.1% between 2010 and 2022.
• Variability in IVI use was mainly attributed to hospital (54%) and physician (33%) factors.
• IVI demonstrated high reliability (>0.96) as a hospital/physician performance measure, but no significant outcome benefit was observed.

Conclusions:

• IVI use in VA PCI is increasing but highly variable across providers.
• IVI meets criteria for a performance measure and should be tracked to promote adoption.
• Further training and quality improvement initiatives are needed to optimize IVI benefits.