Adoption of intravascular imaging-guided percutaneous coronary intervention in the United States (2012-2022): temporal trends, disparities, and mortality association.
- 1Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China.
- 2Department of Cardiology, Dehui City People's Hospital, Changchun, China.
Abstract
Background
Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI), using intravascular ultrasound (IVUS) or optical coherence tomography (OCT), improves clinical outcomes. Contemporary data on US adoption trends, demographic, and hospital disparities remain limited.Methods and results
We analyzed 5,220,590 PCI admissions from the National Inpatient Sample (2012-2022). IVI use was defined by concurrent procedural codes for IVUS or OCT. Outcomes included temporal trends, in-hospital mortality, resource utilization, and disparities. Given the large sample size, standardized mean differences (SMDs) were reported to quantify between-group differences, with an absolute SMD of >0.10 indicating a meaningful imbalance. Multivariable logistic regression was adjusted for demographics, comorbidities, and hospital characteristics. To further address potential confounding by indication, propensity score matching was performed. Patients were matched 1:1 using nearest-neighbor matching without replacement, with a caliper of 0.2 standard deviations of the propensity score and exact matching on calendar year. Covariate balance before and after matching was assessed using absolute SMDs, with an absolute SMD <0.10 indicating an adequate balance. IVI-guided PCI increased from 7.1% (2012) to 21.3% (2022) (p trend < 0.001). Minimal demographic disparities existed, but significant hospital-level variations were observed; hospitals in the Northeast had the highest adoption (27.6% in 2022 vs. 16.3% in Western hospitals). In-hospital mortality occurred in 2.32% of IVI hospitalizations compared with 2.88% of hospitalizations without IVI guidance. After adjusting for demographic characteristics, acute clinical presentation and severity-including STEMI, NSTEMI, cardiogenic shock, and cardiac arrest-comorbidities, payer, hospital characteristics, and calendar year, IVI remained significantly associated with lower odds of in-hospital mortality (aOR 0.783, 95% CI 0.742-0.827; P < 0.001), higher routine discharge rates (84.1% vs. 83.7%; p < 0.001), longer median length-of-stay (3 days [interquartile range (IQR) 2-5] vs. 2 days [IQR 2-4]; p < 0.001), and increased costs [$25,144 (IQR 18,749−36,439) vs. $20,165 (IQR 15,293−28,381); p < 0.001].Conclusion
While IVI-guided PCI adoption increased significantly, pronounced hospital-level disparities exist. Targeted efforts to enhance adoption-particularly in rural, non-teaching hospitals and low-utilization regions-are needed.
Related
- Ultra-low contrast intravascular ultrasound-guided percutaneous coronary intervention of the left main and left anterior descending artery in advanced chronic kidney disease
- Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a reconstructed individual participant data meta-analysis of randomized controlled trials of intravascular ultrasound- and optical coherence tomography-guided strategies
- Stent-less percutaneous coronary intervention for a severely calcified coronary lesion using combined orbital atherectomy and intravascular lithotripsy followed by drug-coated balloon: case report
- Association Between Admission Calculated Serum Osmolality and New-Onset Atrial Fibrillation in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
- Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention
BibTeX
@article{zhang2026adoption,
title = {{Adoption of intravascular imaging-guided percutaneous coronary intervention in the United States (2012-2022): temporal trends, disparities, and mortality association.}},
author = {Yangyang Zhang and Mingyou Zhang and Tong Li and Guowei Zhang and Zheng Xu},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1930050},
url = {https://europepmc.org/article/MED/42909189},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adoption of intravascular imaging-guided percutaneous coronary intervention in the United States (2012-2022): temporal trends, disparities, and mortality association.
AU - Yangyang Zhang
AU - Mingyou Zhang
AU - Tong Li
AU - Guowei Zhang
AU - Zheng Xu
PY - 2026
DA - 2026/10/07
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1930050
UR - https://europepmc.org/article/MED/42909189
AB - Background Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI), using intravascular ultrasound (IVUS) or optical coherence tomography (OCT), improves clinical outcomes. Contemporary data on US adoption trends, demographic, and hospital disparities remain limited.Methods and results We analyzed 5,220,590 PCI admissions from the National Inpatient Sample (2012-2022). IVI use was defined by concurrent procedural codes for IVUS or OCT. Outcomes included temporal trends, in-hospital mortality, resource utilization, and disparities. Given the large sample size, standardized mean differences (SMDs) were reported to quantify between-group differences, with an absolute SMD of >0.10 indicating a meaningful imbalance. Multivariable logistic regression was adjusted for demographics, comorbidities, and hospital characteristics. To further address potential confounding by indication, propensity score matching was performed. Patients were matched 1:1 using nearest-neighbor matching without replacement, with a caliper of 0.2 standard deviations of the propensity score and exact matching on calendar year. Covariate balance before and after matching was assessed using absolute SMDs, with an absolute SMD <0.10 indicating an adequate balance. IVI-guided PCI increased from 7.1% (2012) to 21.3% (2022) (p trend < 0.001). Minimal demographic disparities existed, but significant hospital-level variations were observed; hospitals in the Northeast had the highest adoption (27.6% in 2022 vs. 16.3% in Western hospitals). In-hospital mortality occurred in 2.32% of IVI hospitalizations compared with 2.88% of hospitalizations without IVI guidance. After adjusting for demographic characteristics, acute clinical presentation and severity-including STEMI, NSTEMI, cardiogenic shock, and cardiac arrest-comorbidities, payer, hospital characteristics, and calendar year, IVI remained significantly associated with lower odds of in-hospital mortality (aOR 0.783, 95% CI 0.742-0.827; P < 0.001), higher routine discharge rates (84.1% vs. 83.7%; p < 0.001), longer median length-of-stay (3 days [interquartile range (IQR) 2-5] vs. 2 days [IQR 2-4]; p < 0.001), and increased costs [$25,144 (IQR 18,749−36,439) vs. $20,165 (IQR 15,293−28,381); p < 0.001].Conclusion While IVI-guided PCI adoption increased significantly, pronounced hospital-level disparities exist. Targeted efforts to enhance adoption-particularly in rural, non-teaching hospitals and low-utilization regions-are needed.
SN - 2297-055X
ER -