经皮冠状动脉介入治疗(PCI)期间血管内超声(IVUS)或光学相干断层扫描(OCT)的使用得到了社会指南的认可。但是美国缺乏关于现实世界结果的数据。
确定了2015年10月至2020年3月进行的住院患者PCI的Medicare索赔数据,并通过ICD-10-PCS代码捕获IVUS/OCT。对基线和手术特征进行三向倾向评分匹配(血管造影vsIVUSvsOCT)。主要不良心血管事件(MACE),死亡的复合,心肌梗死(MI),或重复血运重建,经过3年的评估,索引PCI后30天的空白窗口,以排除分阶段的程序。
■在502,821个PCI程序中,463,201(92%)仅由血管造影引导,IVUS或OCT用于37,908(7.5%)和1712(0.3%),分别。在倾向匹配之后,与血管造影相比,主要不良心血管事件的风险与IVUS相似(风险比[HR],0.97;95%CI,0.91-1.03;P=.285),但OCT较低(HR,0.85;95%CI,0.77-0.94;P=.001)。在临床相关亚组中观察到类似的趋势。与单纯血管造影相比,OCT显示MI或重复血运重建的风险较低(HR,0.86;95%CI,0.76-0.97;P=0.015),IVUS单独发生MI的风险较低(HR,0.90;95%CI,0.82-0.99;P=0.038)。
■在现实世界的美国队列中,在PCI期间不经常使用IVUS和OCT。与单纯血管造影相比,在首次PCI期间使用冠状动脉成像与3年内临床事件发生率较低相关.
UNASSIGNED: Use of intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is endorsed by society guidelines, but US data on real-world outcomes are lacking.
UNASSIGNED: Medicare claims data were identified for inpatient PCIs performed October 2015 to March 2020, with IVUS/OCT captured by ICD-10-PCS codes. Three-way propensity score matching (angio vs IVUS vs OCT) on baseline and procedural characteristics was performed. Major adverse cardiovascular events (MACE), a composite of death, myocardial infarction (MI), or repeat
revascularization, was evaluated through 3 years, with a 30-day blanking window after index PCI to exclude staged procedures.
UNASSIGNED: Of the 502,821 PCI procedures, 463,201 (92%) were guided by angiography alone, with IVUS or OCT used in 37,908 (7.5%) and 1712 (0.3%), respectively. After propensity matching, compared with angiography, the risk of major adverse cardiovascular event was similar for IVUS (hazard ratio [HR], 0.97; 95% CI, 0.91-1.03; P = .285) but lower for OCT (HR, 0.85; 95% CI, 0.77-0.94; P = .001). A similar trend was observed in clinically relevant subgroups. Compared with angiography alone, the risk of MI or repeat
revascularization was lower with OCT (HR, 0.86; 95% CI, 0.76-0.97; P = .015), and the risk of MI alone was lower with IVUS (HR, 0.90; 95% CI, 0.82-0.99; P = .038).
UNASSIGNED: In a real-world US cohort, IVUS and OCT were used infrequently during PCI. Compared with angiography alone, use of intracoronary imaging during index PCI was associated with lower rates of clinical events through 3 years.