A 10-Year Review of Intravascular Imaging Use in Australia: Findings From a Statewide Registry

In several recent randomised trials, intravascular imaging (IVI)-guided percutaneous intervention (PCI) has demonstrated superiority to angiography-guided PCI, particularly, in certain lesion subsets. Given the recent Medicare Benefits Schedule (MBS) criteria changes to incorporate intravascular ultrasound (IVUS) for PCI, we sought to report the real-world use of IVI.

Consecutive patients undergoing PCI entered into the Victorian Cardiac Outcomes Registry from 2013 to 2022 were included. Patients presenting with cardiogenic shock or out-of-hospital cardiac arrest requiring intubation were excluded given their distinct clinical urgency and unstable physiology. The overall use of either IVUS and optical coherence tomography (OCT) was assessed. Additionally, we assessed the use of IVI in PCI in scenarios as per MBS criteria: lesion length ≥28 mm (using stent length as a surrogate marker) and left main PCI, as well as in cases of in-stent restenosis.

A total of 104,722 PCI procedures were included. IVUS/OCT was used in 3,137 (3.0%) cases. There was a significant increase in rates of IVI-PCI over the study period, increasing from 2.2% (n=105 of 4,809) in 2013 to 6.3% (n=730 of 11,651) in 2022 (p=0.005). Comparing 2013-2017 with 2018-2022, there was a significant increase in IVUS/OCT use for left main disease (p=0.01) and PCIs with stent length ≥28 mm (p=0.001). Of the 39,492 PCI cases with stent length ≥28 mm, IVUS/OCT was used in 3.3% of cases (1,313), with these patients being younger (p=0.001) and more likely to have diabetes (p=0.001) and previous PCI (p=0.001). Of the 1,831 left main PCI cases, IVI was used in 460 (25.1%).

Although IVI use has grown significantly, 75% of left main coronary artery PCIs have still been done without imaging. With recent MBS changes, we anticipate further growth for IVI-guided PCI.