Use of imaging guidance during PCI has doubled in recent years:
Use of imaging guidance during PCI has doubled in recent years:
Published on July 3, 2025, in The American Journal of Cardiology.
– Key Findings (July 2025)
1. Significant Growth in Use:
• Intracoronary imaging (ICI) guidance during percutaneous coronary intervention (PCI) has nearly doubled in recent years across the U.S.
• Overall usage rose from 6.8% in 2016 to 13.5% in 2020.
2. Modalities Breakdown:
• IVUS (Intravascular Ultrasound) increased from 6.5% to 12.9%.
• OCT (Optical Coherence Tomography) usage rose slightly from 0.3% to 0.7%.
3. Regional Variability:
• Western U.S.: Highest Intracoronary imaging (ICI) usage (12.6%).
• Midwest: 8.9%; Northeast: 9.9%; South: Lowest at 7.6%.
4. Clinical Benefits:
• Both IVUS and OCT are associated with lower mortality rates post-PCI compared to angiography-guided PCI.
5. Barriers to Adoption:
• Limited training.
• Technical complexity and interpretation challenges.
• Longer procedure times, higher radiation, and lack of workflow standardization.
• Cost-effectiveness concerns.
6. Factors Promoting ICI Use:
• Higher use in:
• Native American patients.
• Patients with COVID-19, prior MI, CHF, or complex PCI cases.
• High-volume PCI centers.
• Privately insured patients and larger hospitals.
• Less common in:
• Acute coronary syndromes (ACS), hypertensive patients, and active smokers, especially in the Southern region.
7. Guideline Influence:
• The 2021 ACC/AHA guidelines lacked strong recommendations for ICI in ACS.
• The 2025 ACC/AHA guidelines now upgrade ICI to a Class I recommendation in ACS, aiming to boost adoption.
8. Conclusion:
• Despite logistical and systemic barriers, ICI usage is rising.
• Support from professional societies (e.g., ACC, AHA) is crucial to expanding adoption and improving patient outcomes.
