Hospital-Level Variability in Use of Intracoronary Imaging for Percutaneous Coronary Intervention in the United States.

Autor:	Malik AO; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.; University of Missouri Kansas City, Kansas City, Missouri., Saxon JT; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.; University of Missouri Kansas City, Kansas City, Missouri., Spertus JA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.; University of Missouri Kansas City, Kansas City, Missouri., Salisbury A; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.; University of Missouri Kansas City, Kansas City, Missouri., Grantham JA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri., Kennedy K; Saint Luke's Mid America Heart Institute, Kansas City, Missouri., Huded CP; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.; University of Missouri Kansas City, Kansas City, Missouri.
Jazyk:	angličtina
Zdroj:	Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2023 May 19; Vol. 2 (4), pp. 100973. Date of Electronic Publication: 2023 May 19 (Print Publication: 2023).
DOI:	10.1016/j.jscai.2023.100973
Abstrakt:	Background: Intracoronary (IC) imaging for percutaneous coronary intervention (PCI) is associated with better patient outcomes and carries a class IIA guideline recommendation, but it remains rarely used. We sought to characterize hospital-level variability in IC imaging for PCI in the United States and to identify factors that may explain this variability. Methods: Patients who underwent PCI, with or without IC imaging, in the Nationwide Readmissions Database (2016-2020) were included. A regression model with a random effect for site was used to generate the median odds ratio (MOR) of IC imaging use for a patient at one site vs another, sequentially adjusting for procedural, patient, and hospital factors to examine the extent to which different factors account for this variability. Results: The analytic cohort included 1,328,517 PCI procedures (patient mean age 65.8 years, 32.4% female, IC imaging used in 9.2%) at 1068 hospitals. The median hospital use of IC imaging increased from 2.7% (IQR, 0.6-7.7) in 2016 to 6.3% (IQR, 1.7-17.8) in 2020. In 2020, the MOR for IC imaging during PCI was 4.6 (IQR, 4.3-5.0), indicating a >4-fold difference in the odds of a patient undergoing IC imaging with PCI at one random hospital vs another. Adjusting for procedure, patient, and hospital factors did not meaningfully alter the MOR. Conclusion: The average US hospital uses IC imaging for <1 in 15 PCI procedures, with marked variability across hospitals. Strategies to increase and standardize the use of IC imaging are needed to improve the quality of PCI in the United States. (© 2023 The Author(s).)
Databáze:	MEDLINE
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