910 Uptake and Utilisation of Intravascular Imaging to Guide Percutaneous Coronary Intervention: Insights from the Victorian Cardiac Outcomes Registry

Abstract

Percutaneous coronary intervention (PCI) remains an established therapeutic option for myocardial revascularisation. Use of intravascular imaging to guide PCI is known to improve clinical outcomes, with this benefit most pronounced when tackling complex lesion subsets. We therefore sought to ascertain the current uptake and use of intravascular imaging based on anonymised data from the Victorian Cardiac Outcomes Registry (VCOR). All consecutive patients undergoing PCI for coronary artery disease (CAD) were included (n=51,044) from January 2013 through December 2018. Intravascular imaging included intravascular ultrasound (IVUS) and optical coherence tomography (OCT) use. Patient/lesion characteristics were obtained and compared between angiographic- and imaging-PCI guided groups. Overall, 873 (1.7%) of patients had intravascular imaging to guide PCI during the study period, with IVUS used in 602 (1.2%), OCT in 246 (0.48%) and both in 25 (0.05%) cases. There was an increase in case rates of intravascular imaging year on year (p=0.001). Intravascular imaging was more commonly used in patients with diabetes (p=0.04) and those with stable CAD (p<0.001). Although angiographically-guided PCI remained the default modality used for treatment of all complex lesion subsets, rates of intravascular imaging use were higher for left-main stem intervention (14.7%), stent thrombosis (9.4%), in-stent restenosis (4.6%), treatment of chronic total occlusions (3.0%) and AHA Type B2/C lesions (1.9%). The uptake of intravascular imaging use during PCI remains limited in Victoria, even when considering more complex PCI procedures. These data should renew our focus on education, reimbursement and support for using intravascular imaging in Australia.