Safety and Effectiveness of Intracoronary Imaging-Guided PCI in Contemporary Practice: Insights From BMC2

Studies suggest percutaneous coronary intervention (PCI) guided by intracoronary imaging (ICI) results in larger balloon/stent diameters and longer stents. Whether this occurs in real-world PCI is poorly understood.

De novo PCIs performed at 48 nonfederal Michigan hospitals between July 2019 and June 2022 were evaluated with regression modeling to evaluate associations between ICI-guided PCI and balloon/stent dimensions. The association between ICI-guided PCI and coronary dissection/perforation was assessed using adjusted odds ratios.

ICI was used in 16 777 (22.5%) PCI-treated lesions and increased from 11.2% of cases in July 2019 to 32.1% in June 2022. Compared with angiography alone, the average patient/procedural-adjusted treatment effect of ICI use included: +0.19 mm stent diameter (95% CI +0.16 to +0.22), +0.45 mm maximum balloon diameter (95% CI +0.40 to +0.51), and +3.51 mm stent length (95% CI +2.54 to +4.48). These findings persisted when controlling for the operator. ICI use was associated with a higher risk of dissections (adjusted odds ratio, 2.55 [95% CI, 2.05-3.16]) and perforations (adjusted odds ratio, 2.25 [95% CI, 1.74-2.91]); however, increased use of ICI and larger stent/balloon sizes over the study period (P<0.001 for trend for both) was not associated with a concomitant increase in rates of dissection or perforation (P=0.78 and P=0.33 for trend, respectively).

In real-world practice, ICI-guided PCI was associated with larger stent/balloon diameters and longer stents. While ICI use was associated with dissections and perforations, there was no significant increase in the rate of these complications despite significant increases in ICI use and stent/balloon sizes during the study period. Further research is needed to evaluate the association between ICI use and procedural complications.