Introduction: Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years. Methods: Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age ≥ 18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p<0.001). The adjusted in-hospital mortality and inpatient LOS for PCI with IVUS showed statistically insignificant trend of higher mortality (1.3% in 2014 vs. 1.6% in 2019, trend p=0.053) and shorter LOS (3.2 days in 2014 vs. 3.0 days in 2019, trend p=0.148). The mean adjusted cost steadily increased over the years for patients undergoing PCI with IVUS (24236$ in 2014 vs. 28700$ in 2019, trend p=0.012). Conclusions: There is a steady rise in use of IVUS during PCI. There is a steady hike in hospital costs for PCI with IVUS hospitalizations however in-hospital mortality and LOS remain the same.