Comparison of outcomes between imaging guided versus angiography guided percutaneous coronary intervention in patients with acute coronary syndrome: insights from the national inpatient sample

Objective

Coronary intravascular imaging allows visualization and characterization of vessel wall. Percutaneous coronary intervention (PCI) using intravascular ultrasound or optical coherence tomography has optimized stent deployment techniques, reduced periprocedural outcomes and reduced long-term major cardiovascular events. We sought to investigate the outcomes of imaging guided to conventional angiography guided PCI with reference to in-hospital mortality, hospital length of stay (LOS) and total hospital charge.

Methods

We performed a retrospective cohort study using data from the 2016–2017 Nationwide Inpatient Sample (NIS) which is the largest collection of inpatient hospitalization data in the United States. Patients admitted with a principal diagnosis of acute coronary syndrome (ACS) who underwent PCI with and without intravascular imaging was determined using the International Classification of Diseases, Tenth revision codes. The primary outcome was inpatient mortality while secondary outcomes are showed in table 1. STATA software was used for the analysis. Multivariate logistic and linear regression models were used to adjust for confounders.

Results

There were over 71 million hospital discharges in the combined 2016 and 2017 NIS database. Admission for ACS in adult patients (aged ≥18 years) who underwent PCI yielded 622,855 results. Among this group, 27, 520 (4.4%) had imaging guided PCI while 595,335 (95.6%) had PCI without imaging.

Patients with imaging guided PCI had lower inpatient mortality (3.2% vs 2.3%, AOR: 0.74, 95% CI 0.60–0.90, p=0.004) compared to PCI with angiographic data alone. Imaging guided PCI had an adjusted increased mean LOS of 0.16 days (3.8 vs 3.7 days, CI: 006–0.26, p=0.002) with an adjusted increased mean total hospital charge of $13, 206 ($120,203 vs $104,916, p= <0.0001).

Conclusion

Patients hospitalized for ACS who had imaging guided PCI had reduced inpatient hospital mortality compared to those who had PCI without imaging guidance. Overall utilization of imaging was less than 5% in 2016–2017, however it is expected to be higher in recent years with improvements in clinical practice, training and available scientific evidence.

Funding Acknowledgement

Type of funding sources: None.