101 - Trend in Utilization of IVUS among patients with peripheral artery disease or critical limb threatening ischemia in the United States

Intravascular ultrasound (IVUS) has become a vital tool in treating peripheral artery disease (PAD) and critical limb-threatening ischemia (CLTI) using catheter-based procedures. Herein, we analyze the trends in utilization of IVUS in the inpatient setting in the United States.

Materials and Methods:

The National Inpatient Sample (NIS) was queried between 2005 to 2020, for adult patients with PAD or CLI receiving endovascular interventions including angioplasty and/or stenting. Patients who received IVUS were further stratified. Cochrane-Armitage test was conducted to assess trends in proportion of IVUS among races. Hierarchical, multivariable logistic regression was used to assess patient profile of those who received IVUS, discharge other than home (DOTH), and in-hospital mortality. Negative binomial regression was conducted to assess risk factors for length of stay (LOS) and total admission charge (adjusted for 2020 dollars).

Results:

There was a total of 599,631 admissions involving PAD between 2005 and 2020. Of these, 11,239 (1.9%) received IVUS. There was an increasing trend in proportion of IVUS use between 2005 to 2020 by 0.12% per year (95% CI: 0.08 to 0.17; p< 0.001). There was no statistically significant relationship between race and IVUS use compared to White patients (all p >0.05). IVUS use was associated with similar odds of in-hospital mortality (OR: 0.90; 95% CI: 0.57-1.43; p=0.67), and lower odds of DOTH (OR: 0.82; 95% CI: 0.67-0.99; p=0.042), lower mean LOS by 12.6% (95% CI: -0.20 to -0.06; p=0.001), and higher mean total charge by 15.8% (95% CI: 0.12 to 0.20; p< 0.001).

There was a total of 746,534 admissions involving CLTI between 2005 and 2020. Of these, 14,866 (2.0%) received IVUS. There was an increasing trend in proportion of IVUS use between 2005 to 2020 by 0.12% per year (95% CI: 0.14 to 0.20; p< 0.001). Compared to White patients, Black patients had lower odds of receiving IVUS (OR: 0.78; 95% CI: 0.62-0.99; p=0.04). IVUS use was associated with similar odds of in-hospital mortality (OR: 1.01; 95% CI: 0.72-1.42; p=0.95), and lower odds of DOTH (OR: 0.76; 95% CI: 0.69-0.85; p< 0.001), lower mean LOS by 13.2% (95% CI: -0.18 to -0.08; p< 0.001), and higher mean total charge by 12.7% (95% CI: 0.08 to 0.17; p< 0.001).

Conclusion:

Trend in IVUS has increased over a 16-year period and was associated with similar odds of in-hospital mortality, lower odds of DOTH, lower rate of LOS, and higher mean total charge. Among CLTI patients, Black patients had lower odds of receiving IVUS compared to White patients. Proceduralists may consider implementing IVUS in their practice.