Impact of Intracoronary Imaging‐Guided Percutaneous Coronary Intervention on Procedural Outcomes Among Complex Patient Groups

BACKGROUND: Intracoronary imaging (ICI) has been shown to improve survival after percutaneous coronary intervention (PCI). Whether this prognostic benefit is sustained across different indications remains unclear. METHODS AND RESULTS: All PCI procedures performed in England and Wales between April, 2014 and March 31, 2020, were retrospectively analyzed. The association between ICI use and in‐hospital major acute cardiovascular and cerebrovascular events; composite of all‐cause mortality, stroke, and reinfarction and mortality was examined using multivariable logistic regression analysis for different imaging‐recommended indications as set by European Association for Percutaneous Cardiovascular Interventions consensus. Of 555 398 PCI procedures, 10.8% (n=59 752) were ICI‐guided. ICI use doubled between 2014 (7.8%) and 2020 (17.5%) and was highest in left main PCI (41.2%) and lowest in acute coronary syndrome (9%). Only specific European Association for Percutaneous Cardiovascular Interventions imaging‐recommended indications were associated with reduced major acute cardiovascular and cerebrovascular events and mortality, including left main PCI (odds ratio [OR], 0.45 [95% CI, 0.39–0.52] and 0.41 [95% CI, 0.35–0.48], respectively), acute coronary syndrome (OR, 0.76 [95% CI, 0.70–0.82] and 0.70 [95% CI, 0.63–0.77]), and stent length >60 mm (OR, 0.75 [95% CI, 0.59–0.94] and 0.72 [95% CI, 0.54–0.95]). Stent thrombosis and renal failure were associated with lower mortality (OR, 0.69 [95% CI, 0.52–0.91]) and major acute cardiovascular and cerebrovascular events (OR, 0.77 [95% CI, 0.60–0.99]), respectively. CONCLUSIONS: ICI use has more than doubled over a 7‐year period at a national level but remains low, with <1 in 5 procedures performed under ICI guidance. In‐hospital survival was better with ICI‐guided than angiography‐guided PCI, albeit only for specific indications.