美国医疗保险实际参保人群中经皮冠状动脉介入治疗期间冠状动脉内成像与临床结局的关联

Association Between Intracoronary Imaging During PCI and Clinical Outcomes in a Real-World US Medicare Population.

作者信息

Bergmark Brian A, Osborn Eric A, Ali Ziad A, Gupta Aakriti, Kolli Kranthi K, Prillinger Julie B, Hasegawa James, West Nick E J, Croce Kevin, Secemsky Eric

机构信息

Cardiovascular Division, Department of Medicine, Complex Coronary/CTO Program, Brigham and Women's Hospital, Boston, Massachusetts.

Cardiovascular Division, Department of Medicine, Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, Massachusetts.

出版信息

J Soc Cardiovasc Angiogr Interv. 2022 Dec 5;2(2):100556. doi: 10.1016/j.jscai.2022.100556. eCollection 2023 Mar-Apr.

BACKGROUND

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.

METHODS

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.

RESULTS

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; = .285) but lower for OCT (HR, 0.85; 95% CI, 0.77-0.94; = .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; = .015), and the risk of MI alone was lower with IVUS (HR, 0.90; 95% CI, 0.82-0.99; = .038).

CONCLUSIONS

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.

背景

经皮冠状动脉介入治疗（PCI）期间使用血管内超声（IVUS）或光学相干断层扫描（OCT）得到了学会指南的认可，但美国缺乏关于实际治疗效果的数据。

方法

确定了2015年10月至2020年3月期间进行的住院PCI的医疗保险理赔数据，IVUS/OCT通过ICD-10-PCS编码获取。根据基线和手术特征进行了三向倾向评分匹配（血管造影术与IVUS与OCT）。通过3年评估主要不良心血管事件（MACE），即死亡、心肌梗死（MI）或再次血运重建的综合情况，在首次PCI后有30天的空白期以排除分期手术。

结果

在502,821例PCI手术中，463,201例（92%）仅由血管造影术引导，IVUS或OCT分别用于37,908例（7.5%）和1712例（0.3%）。倾向评分匹配后，与血管造影术相比，IVUS发生主要不良心血管事件的风险相似（风险比[HR]，0.97；95%置信区间，0.91 - 1.03；P = 0.285），但OCT较低（HR，0.85；95%置信区间，0.77 - 0.94；P = 0.001）。在临床相关亚组中观察到类似趋势。与仅血管造影术相比，OCT发生MI或再次血运重建的风险较低（HR，0.86；95%置信区间，0.76 - 0.97；P = 0.015），IVUS单独发生MI的风险较低（HR，0.90；95%置信区间，0.82 - 0.99；P = 0.038）。