Real-World Analysis of Healthcare Resource Utilization in Patents With Coronary Artery Disease Undergoing Paclitaxel-Coated Balloon Angioplasty With and Without Intravascular Ultrasound Guidance
Author(s)
Ruth Sim, Phd1, Vireender Kaur, BSc1, Jas Min Tan, BSc1, Clement Lim, PhD, MD2, Callix C. Wong, BSc, MSc2, Chee Yoong Foo, PhD, MD1, Tamil Selvan Muthusamy, MD3.
1IQVIA, Petaling Jaya, Malaysia, 2Boston Scientific, Singapore, Singapore, 3Cardiac Vascular Sentral (CVS) Hospital, Kuala Lumpur, Malaysia.
1IQVIA, Petaling Jaya, Malaysia, 2Boston Scientific, Singapore, Singapore, 3Cardiac Vascular Sentral (CVS) Hospital, Kuala Lumpur, Malaysia.
OBJECTIVES: This study aimed to evaluate the real-world impact of intravascular ultrasound (IVUS) guidance during paclitaxel drug-coated balloons (DCB) angioplasty in patients with coronary artery disease (CAD) on healthcare resource utilization (HRU) and clinical outcomes.
METHODS: We conducted a retrospective cohort study on patients who received angioplasty using AgentTM at a tertiary cardiac centre in Malaysia between January 1, 2019 and December 31, 2023. Lesions were managed with or without IVUS guidance at operator's discretion. We assessed clinical outcomes such as 12-month angiographic restenosis and target lesion revascularization (TLR). We also compared HRU (rehospitalizations, emergency department [ED] visits, and outpatient department [OPD] visits) within 12 months post-DCB angioplasty for IVUS vs. non-IVUS groups. Adjustments were made for baseline patients and lesion characteristics.
RESULTS: Of 1,668 lesions treated in 1,245 patients, 39.3% were managed with IVUS guidance ('IVUS' group), and 60.7% without ('non-IVUS' group). At baseline, lesions were predominantly de novo (87.1%). In-stent restenosis (ISR) or restenosis (no prior stent) was more prevalent in the IVUS group (20.7% vs. 7.8%; p<0.001). Lesion complexity was significantly greater in the IVUS group, with more Type C lesions (80.5% vs. 56.3%; p<0.001) and calcified lesions (11.0% vs. 5.3%; p<0.001). A significant reduction in restenosis risk was observed in the IVUS group (adjusted HR 0.51; p<0.05), with a low (1.5%) and comparable TLR rate between groups. As expected for patients with greater lesion complexity, ED visit rate was higher in the IVUS group (0.22 vs. 0.20, p<0.05), with no difference in the adjusted rehospitalization (0.18 vs. 0.16; p=0.315) or OPD visit (4.31 vs. 4.45; p=0.469) rates.
CONCLUSIONS: The lower restenosis rate in the IVUS group highlights its clinical advantage. IVUS-guided DCB angioplasty could potentially optimize HRU in patients with complex coronary lesion by reducing the need for future interventions.
METHODS: We conducted a retrospective cohort study on patients who received angioplasty using AgentTM at a tertiary cardiac centre in Malaysia between January 1, 2019 and December 31, 2023. Lesions were managed with or without IVUS guidance at operator's discretion. We assessed clinical outcomes such as 12-month angiographic restenosis and target lesion revascularization (TLR). We also compared HRU (rehospitalizations, emergency department [ED] visits, and outpatient department [OPD] visits) within 12 months post-DCB angioplasty for IVUS vs. non-IVUS groups. Adjustments were made for baseline patients and lesion characteristics.
RESULTS: Of 1,668 lesions treated in 1,245 patients, 39.3% were managed with IVUS guidance ('IVUS' group), and 60.7% without ('non-IVUS' group). At baseline, lesions were predominantly de novo (87.1%). In-stent restenosis (ISR) or restenosis (no prior stent) was more prevalent in the IVUS group (20.7% vs. 7.8%; p<0.001). Lesion complexity was significantly greater in the IVUS group, with more Type C lesions (80.5% vs. 56.3%; p<0.001) and calcified lesions (11.0% vs. 5.3%; p<0.001). A significant reduction in restenosis risk was observed in the IVUS group (adjusted HR 0.51; p<0.05), with a low (1.5%) and comparable TLR rate between groups. As expected for patients with greater lesion complexity, ED visit rate was higher in the IVUS group (0.22 vs. 0.20, p<0.05), with no difference in the adjusted rehospitalization (0.18 vs. 0.16; p=0.315) or OPD visit (4.31 vs. 4.45; p=0.469) rates.
CONCLUSIONS: The lower restenosis rate in the IVUS group highlights its clinical advantage. IVUS-guided DCB angioplasty could potentially optimize HRU in patients with complex coronary lesion by reducing the need for future interventions.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD64
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)