The use of intravascular ultrasound during percutaneous coronary intervention does not reduce all cause in-hospital mortality but doubles the cost, with higher utilization in privately insured patients.

Abstract

Introduction: The effect of using intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) on short-term mortality is not well established.

Aim: To evaluate any association between the use of IVUS vs. no IVUS during PCI and mortality in a large inpatient database.

Material and methods: We used the National Inpatient Sample (NIS) database for available ICD-10 codes from 2016-2020 for IVUS and PCIs.

Results: A total of 10,059,56 PCIs were performed. In 206,910, IVUS-guided PCI was performed vs. 9,852,359 without IVUS. Mortality did not differ between the two groups, with 2.52% mortality in the IVUS arm vs. 2.59% in no IVUS cohort, p = 0.4. The mean age of patients with IVUS use was 65.5 vs. 70.1 years without IVUS, p < 0.001. Total in-hospital cost in the IVUS group was double that without IVUS ($141,920 vs. $71,568, p < 0.001). Furthermore, IVUS utilization was significantly higher in patients with private health insurance (28.3% vs. 17.2%, p < 0.001).

Conclusions: In-patient all-cause mortality using IVUS during PCI was similar to that in patients without IVUS utilization, but the cost was doubled, with higher utilization in privately insured patients.