Use of Intravascular Imaging to Guide Percutaneous Coronary Interventions: Experience from a Single, High-Volume...

Intravascular imaging (IVI) improves outcomes in complex percutaneous coronary intervention (PCI) and is recommended by the latest guidelines. However, data about its real-world application remain limited.

We conducted a retrospective audit of 300 consecutive PCI cases. Lesions were classified as complex if they involved > 1 of the following characteristics: bifurcation, severe calcifications, chronic total occlusion, long lesions, ostial location, and involvement of the left main artery. IVI use was analyzed by lesion subtype and individual operator.

Of 300 consecutive PCI cases, 146 (49%) were classified as complex PCI. IVI was used in 53% of complex PCIs and 23% of noncomplex PCIs. Among patients undergoing complex PCI, IVI was most frequently performed in chronic total occlusions (86%) and left main disease (76%), but its use remained below 50% for bifurcations, severe calcified lesions, and long lesions. IVI-guided PCI was associated with higher contrast use (215 ± 78 vs 179 ± 65 mL, P = 0.003) and longer procedural duration (72 ± 32 vs 51 ± 22 minutes, P < 0.001) and varied widely across operators, ranging from 0%-79% in the overall population (P < 0.001) to 0%-90% in complex lesions (P = 0.004). Notably, IVI adoption declined with increasing operator age (odds ratio, 0.88 per +1 year; 95% confidence interval 0.78-0.98), whereas it increased with lesion complexity (odds ratio 2.34 per additional complexity feature; 95% confidence interval 1 1.62-3.39).

Despite current evidence and guideline recommendations, IVI use showed notable variation across operators. Standardizing IVI utilization through education, protocols, and system-level support are essential to promoting guideline-concordant practice.