Use of Intravascular Imaging to Guide Percutaneous Coronary Interventions: Experience from a Single, High-Volume Canadian Centre
Bibliographic record
Abstract
Background Intravascular imaging (IVI) improves outcomes in complex percutaneous coronary intervention (PCI) and is recommended by the latest guidelines. However, data about its real-world application remains limited. Methods We conducted a retrospective audit of 300 consecutive PCI cases. Lesions were classified as complex if they involved >1 following characteristics: bifurcation, severe calcifications, CTO, long lesions, ostial location and involvement of the LM. IVI use was analyzed by lesion subtype and individual operator. Results Of 300 consecutive PCI cases, 146 (49%) were classified as complex PCI. IVI was used in 53% of complex PCIs and 23% of noncomplex PCIs. Among patients undergoing complex PCI, IVI was most frequently performed in CTOs (86%) and LM (76%), but its use remained below 50% for bifurcations, severe calcified and long lesions. IVI-guided PCI was associated with higher contrast use (215 ± 78 mL vs. 179 ± 65 mL, P=0.003) and longer procedural duration (72 ± 32 minutes vs. 51 ± 22 minutes, P < 0.001) and varied widely across operators, ranging from 0-79% in the overall population (p<0.001) to 0-90% in complex lesions (p=0.004). Notably, IVI adoption declined with increasing operator age (OR 0.88 per +1 year; 95% CI 0.78–0.98), whereas it increased with lesion complexity (OR 2.34 per additional complexity feature; 95% CI 1 1.62–3.39). Conclusions Despite current evidence and guideline recommendations, IVI use showed notable variation across operators. Standardizing IVI utilization through education, protocols, and system-level support will be essential to promote guideline-concordant practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".