Trends and outcomes of intravascular imaging in patients undergoing percutaneous coronary intervention for coronary chronic total occlusion: a 5-year retrospective analysis

Abstract

Abstract Background Elderly patients with coronary chronic total occlusions (CTO) represent a vulnerable population with comorbid conditions and complex coronary anatomy. Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). There is limited data on its impact in patients undergoing percutaneous coronary intervention (PCI) for coronary CTO. Purpose We aimed to identify the trends in utilization of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in patients undergoing single vessel (SV) - CTO PCI and its impact on clinical outcomes. Methods We queried the Nationwide Inpatient Sample database to identify hospitalizations for SV PCI between 2016 – 2020. Patients with CTO were identified using the ICD-10 diagnosis code. The use of IVUS and OCT was identified using the ICD-10 codes. We compared utilization of IVUS-OCT for SV-CTO PCI to those without and studied the impact of their utilization on clinical outcomes. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes included in-hospital mortality, re-infarction, stroke and post-procedural AKI. Outcomes were compared using univariate and multivariate logistic regression analysis. Results A total of 135,745 weighted hospitalizations for SV CTO-PCI were identified of which 13,610 (10%) utilized IVUS/OCT (mean age 66+/-12, 26.5 % females). Hospitalizations were stratified by patient age into a younger cohort <75 years (mean age 61 ± 9 years) and an older cohort ≥75 years (mean age 81 + 4). Male sex, Caucasians, and admissions to a large urban hospital were associated with higher IVUS/OCT use in both cohorts (p < 0.001). The use of IVUS/OCT was associated with significantly lower MACCE (aOR 0.73, 95% CI 0.6 - 0.8, p < 0.001) and lower incidence of re-infarction in both cohorts (OR 0.6, 95% CI 0.5-0.6, p<0.001 for both cohorts). In-hospital mortality was significantly lower in both cohorts utilizing intravascular imaging (OR 0.8, 95% CI 0.7-1.0, p<0.05 for age ≥75 years and OR 0.6, 95% CI 0.5-0.7, p <0.001) for age < 75). Overall, the rates of stroke and length of stay (4 + 5 days) were comparable but associated with higher hospitalization costs (153k-170k vs 110k-120k, p < 0.001). In patients undergoing CTO-PCI, there was an increasing trend towards the utilization of IVUS and OCT over the study period. Conclusion The use of IVUS/OCT guidance for CTO-PCI was associated with a significant reduction in MACCE, re-infarction and in hospital mortality regardless of age. There was a significant increase in the utilization of IVUS and OCT for the study period in all groups.