Nationwide Trends in Intravascular Ultrasound Use and Outcomes in Elderly Peripheral Vascular Disease Patients Hospitalized withMyocardial Infarction and Undergoing Percutaneous Coronary Intervention, 2016-2020

Introduction: Many older adults with peripheral vascular disease (PVD) have multiple comorbidities and often experience worse outcomes after a heart attack (MI). Intravascular ultrasound (IVUS) is sometimes used during percutaneous coronary intervention (PCI) to better visualize the coronary arteries and identify blockages. However, it remains unclear how frequently IVUS is used in these patients or whether it improves outcomes for elderly PVD patients undergoing PCI for MI. Methods: We analyzed data from the National Inpatient Sample database for the years 2016 to 2020. The study included patients aged 65 or older with peripheral vascular disease (PVD) who were hospitalized for a heart attack (MI) and underwent PCI. We identified these patients using ICD-10 codes and divided them into groups based on whether IVUS was used during PCI. We compared their baseline characteristics, tracked changes in IVUS use over time, and reviewed their hospital outcomes. The main outcome measured was death from any cause during the hospital stay. We used statistical methods to account for differences in patient backgrounds, hospital types, and other health conditions. Results: From 2016 to 2020, 117,245 older patients with PVD who experienced a heart attack underwent PCI. IVUS was used in 10,345 cases, representing 8.8%. Most patients were men (62.1%) and White (83.2%). IVUS use increased each year among both men and women and across racial groups. After adjusting for other factors, IVUS use did not result in a significant reduction in in-hospital deaths compared to PCI without IVUS. However, among those who had IVUS-guided PCI, men had lower in-hospital death rates than women. Discussion: Although IVUS use increased over time, it was not associated with better short-term survival in these older PVD patients. The differences between men and women may be related to heart anatomy, blood vessel size, disease severity, or other factors not fully captured in the data. Conclusion: IVUS is now used more frequently during PCI in older PVD patients with heart attacks. However, we did not find a clear benefit in reducing in-hospital deaths. The differences in outcomes between men and women suggest that IVUS may not have the same effect for all patients. More longterm studies are needed to determine which patients benefit most from IVUS.