Impact of systematic intravascular imaging on the outcomes of complex and higher-risk percutaneous coronary intervention.

Background: Intravascular imaging (IVI) improves the outcomes of percutaneous coronary intervention (PCI). However, the benefit of a systematic approach versus an already higher usage rate remains unclear. This study investigates the short-term impact of systematic IVI utilization during PCI in a complex higher-risk interventional PCI (CHIP-PCI) center.

Methods: This retrospective study analyzed all patients undergoing PCI at a single center between April 2018 and March 2024. Participants were divided into groups based on IVI usage (systematic IVI: ≥80 % of procedures; non-systematic IVI: <80 %). Study endpoints included procedural metrics and in-hospital outcomes.

Results: We analyzed 5547 PCI procedures: 2529 in the non-systematic IVI group (2018-2020) and 3018 in the systematic IVI group (2021-2024). PCI was performed for multivessel disease in 835 patients (15.1 %), left main disease in 957 (17.3 %), and chronic total occlusion in 2040 (36.8 %). Mechanical circulatory support was used in 385 (6.9 %). Atherectomy and intravascular lithotripsy were performed in 1409 (25.4 %) and 249 (4.5 %), respectively. After propensity score matching, -2,305 pairs were evaluated. Procedural and fluoroscopy time were similar between groups, while air kerma (577 vs. 688 mGy, p < 0.001) and contrast volume (96 ± 45 vs. 100 ± 47 ml, p = 0.005) were lower in the systematic IVI group. Systematic IVI was also associated with reduced cardiac tamponade rates (0.8 % vs. 1.6 %, p = 0.015) without differences in other cardiac-related complications.

Conclusions: In this large cohort of CHIP-PCI procedures performed at a highly specialized center, systematic IVI implementation was associated with lower radiation dose and contrast volume, as well as lower incidence of cardiac tamponade, at the expense of a slightly prolonged procedural time.