F-40 | Meta-Analysis on Optical Coherence Tomography-guided vs Angiography-guided Percutaneous Coronary Intervention

Background: The trends and optimal use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) have not been well studied in patients with cancer, who pose an increased bleeding and thrombotic risk in the setting of an acute myocardial infarction (AMI).Methods: BAyesian Machine learning-augmented Propensity Score (BAM-PS) multivariable regression was used with the United States' largest all-payor inpatient dataset.Results: Of the 148,755,036 adult hospitalizations from 2016-2020, there were 5,712,193 (3.84%) AMIs, of which 2,460,813 (43.08%) received LHC, and of which 71,117 (2.89%) were done in patients with active cancer.In STEMI FFR, cancer remained largely stable across the study period: 2016 (8.70%), 2017 (9.09%), 2018 (8.97%), 2019 (10.69%), 2020 (9.27%).This was also true for OCT: 2016 (11.43%), 2017 (11.27%), 2018 (10.00%), 2019 (5.96%), 2020 (17.14%).IVUS was similar as well: 2016 (8.98%), 2017 (10.02%), 2018 (9.70%), 2019 (9.34%), 2020 (9.54%).In BAM-PS multivariable regression controlling for clinical confounders in AMI, cancer significantly increased the odds of receiving OCT rather than PCI alone (OR 1.46, 95%CI 1.07-1.98,p0.017), though the odds were comparable in FFR and IVUS.In cancer, mortality was significantly reduced with IVUS versus PCI alone (OR 0.69, 95%CI 0.56-0.86,p0.001), and comparable for FFR and OCT.Total hospitalization costs were also significantly reduced for IVUS versus PCI alone (US $-23,856.99,145.19, p<0.001).In AMI with cancer, IVUS versus PCI alone was significantly more likely for those living in metros of 50,000-249,000 people versus central metros of at least 1 million (OR 0.79) in addition to West North Central (OR 0.46), East South Central (OR 0.72), South Atlantic (OR 0.76), and Mountain regions (OR 0.72) compared to New England (all p<0.05).Conclusions: This nationally representative artificial intelligence analysis suggests the persistent underutilization of FFR, IVUS, and OCT in patients with cancer and coronary artery disease.Additionally, IVUS guided PCI showed a possible mortality and cost-saving benefit in these patients.