Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction

Saraschandra Vallabhajosyula, Stephanie C. El Hajj, Malcolm R. Bell, Abhiram Prasad, Amir Lerman, Charanjit S. Rihal, David R. Holmes, Gregory W. Barsness

Research output: Contribution to journalArticle

Abstract

Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95% confidence interval 0.50–0.56]), more frequent discharges to home (83.7% vs. 76.8%), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2019

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Optical Coherence Tomography
Myocardial Infarction
Percutaneous Coronary Intervention
Hospital Mortality
Insurance Coverage
Cardiogenic Shock
Urban Hospitals
Heart Arrest
Coronary Angiography
Inpatients
Length of Stay
Hospitalization
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals
Technology
Costs and Cost Analysis
Control Groups

Keywords

  • acute myocardial infarction
  • fractional flow reserve
  • intravascular ultrasound
  • optical coherence tomography
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction. / Vallabhajosyula, Saraschandra; El Hajj, Stephanie C.; Bell, Malcolm R.; Prasad, Abhiram; Lerman, Amir; Rihal, Charanjit S.; Holmes, David R.; Barsness, Gregory W.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

Vallabhajosyula, Saraschandra ; El Hajj, Stephanie C. ; Bell, Malcolm R. ; Prasad, Abhiram ; Lerman, Amir ; Rihal, Charanjit S. ; Holmes, David R. ; Barsness, Gregory W. / Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction. In: Catheterization and Cardiovascular Interventions. 2019.
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abstract = "Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6{\%}, 0.1{\%}, and 0.6{\%}, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2{\%} of the IVUS, OCT, or FFR cohort compared to 64.2{\%} of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95{\%} confidence interval 0.50–0.56]), more frequent discharges to home (83.7{\%} vs. 76.8{\%}), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.",
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AU - Vallabhajosyula, Saraschandra

AU - El Hajj, Stephanie C.

AU - Bell, Malcolm R.

AU - Prasad, Abhiram

AU - Lerman, Amir

AU - Rihal, Charanjit S.

AU - Holmes, David R.

AU - Barsness, Gregory W.

PY - 2019/1/1

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N2 - Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95% confidence interval 0.50–0.56]), more frequent discharges to home (83.7% vs. 76.8%), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.

AB - Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95% confidence interval 0.50–0.56]), more frequent discharges to home (83.7% vs. 76.8%), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.

KW - acute myocardial infarction

KW - fractional flow reserve

KW - intravascular ultrasound

KW - optical coherence tomography

KW - percutaneous coronary intervention

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