Contemporary Use of Intracoronary Imaging and Invasive Physiological Assessment During Coronary Angiography...

Intracoronary imaging (ICI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT), along with invasive physiological assessments (IPA - fractional flow reserve [FFR] or the adenosine-free pressure indices), complement conventional angiography for coronary artery disease assessment. Increasing evidence demonstrates that these technologies improve percutaneous coronary intervention (PCI) outcomes and reduce complications. We reviewed the contemporary use of ICI and IPA in New Zealand.

Data was extracted from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) ACS and Cath-PCI registries from 1 July 2017 until 31 October 2023. ICI and IPA use were analysed for patients who underwent coronary angiography for a non-ST elevation acute coronary syndrome (NSTEACS) or non-acute coronary syndrome chest pain.

The 'NSTEACS' cohort included 31,599 patients (69.1% male, mean age 66.1±11.4 years) undergoing 35,251 procedures. ICI and IPA usage increased over the study period (p<0.001). IVUS was most frequently used for complex multi-vessel and left main stem (LMS) disease (7.6% and 15.5%, respectively); OCT mostly for single vessel disease (4.7%); and IPA use mostly for multi-vessel disease (10.7%). ICI guidance for PCI is low overall (IVUS 12.3%, OCT 4.7%); however, PCI rates are higher in ICI cases (p<0.001), and lower when IPA is used (p=0.003). The 'chest pain syndrome' cohort included 34,446 patients (66.5% male, mean age 66.4±11.2 years) undergoing 40,148 procedures. ICI and IPA usage increased over the study period (p<0.001). IVUS was most often used for complex coronary disease, particularly LMS (15.3%); OCT mostly for single vessel disease (3.7%); with IPA use similar for single (14.0%) and multi-vessel disease (13.1%). ICI guidance for PCI is low overall (IVUS 18.7%, OCT 5.7%); however, PCI rates are higher when ICI or IPA are used (p<0.001).

ICI and IPA are infrequently used for NSTEACS and chest pain syndrome patients in New Zealand. Utilisation is increasing in-keeping with growing evidence and guideline recommendations.