Temporal Trends in Coronary Physiology Testing and Intravascular Imaging Adoption in Poland (2014-2025)

Intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) improve percutaneous coronary intervention (PCI) outcomes. However, their adoption varies globally due to clinical, economic, and healthcare policy factors.

To analyze temporal trends in coronary physiology testing and intravascular imaging utilization in Poland from 2014 to 2025, and to evaluate the impact of national reimbursement policies and European Society of Cardiology guideline evolution on adoption patterns.

We conducted a retrospective analysis using data from the Polish National Registry of PCI (ORPKI), a mandatory prospective registry capturing > 85% of national PCI procedures. All patients undergoing coronary angiography or PCI between January 2014 and June 2025 were included. Temporal trends were assessed using Cochran-Armitage test for trend.

Among 2,244,689 coronary procedures, utilization of adjunctive diagnostic modalities increased significantly: FFR during coronary angiography from 1.6% to 9.2%, IVUS during PCI from 0.7% to 15.0%, and OCT during PCI from 0.2% to 1.7% (all p for trend < 0.001). Adoption was higher in male patients, elective procedures, and complex lesions (left main coronary artery and proximal left anterior descending artery), with IVUS utilization reaching 47% in rotational atherectomy procedures by 2025. Substantial inter-center heterogeneity was observed, with high-adopting centers achieving > 30% IVUS and > 5% OCT utilization rates. Gini coefficient analysis revealed moderate inequality for FFR (0.32) and IVUS (0.35), but marked concentration for OCT (0.73), indicating limited diffusion across centers.

Coronary physiology testing and intravascular imaging utilization in Poland increased substantially over the study period, coinciding with reimbursement policy implementation and guideline updates. Despite this progress, clinical adoption remains below international standards, with persistent sex-based disparities and pronounced inter-center variability representing key targets for quality improvement initiatives.