Analysis of US Medicare data from 2016 to 2023 shows a gradual increase in the dual use of intravascular imaging (IVI) and invasive physiology (IP) during percutaneous coronary intervention (PCI), although overall adoption remains limited. This combined approach, as well as each modality used individually, was associated with fewer major adverse cardiovascular events (MACE) at 2 years and lower long-term healthcare costs compared with angiography alone. The study was published in JACC: Cardiovascular Interventions by Frank A. and colleagues.The application of advanced procedural guidance during PCI has grown over the last decade, although the real-world experience with combined IVI and IP in the United States has not been fully defined. This is a retrospective observational study that utilized Medicare fee-for-service claims data from 2016 through 2023. Patients aged 65 years or older who underwent their first PCI during the study period were included in the outcomes analysis. Procedural approaches were defined as either angiography alone, IVI alone, IP alone, or both IVI and IP. Outcomes were evaluated using multivariable Cox proportional hazards models, whereas cost analyses were conducted using gamma regression models.Over the period from 2016 to 2023, a total of 2,538,154 PCI procedures were conducted on 1,958,990 patients. After applying the inclusion and exclusion criteria, a total of 1,587,532 patients were considered for the final outcome analysis. This is one of the largest real-world analyses of PCI guidance strategies in the Medicare population in the U.S.Key findingsIVI was employed in about 15% of all PCI procedures, IP in 7%, and combined IVI and IP in 2.5%. However, the use of these modalities has increased significantly over time. In 2023, the use of IVI increased to almost 30% of all PCIs, and combined IVI and IP to 4.7%. The major outcome was major adverse cardiovascular events at 2 years, a composite of myocardial infarction, repeat revascularization, and all-cause mortality.The use of dual IVI and IP was significantly associated with reduced rates of MACE compared with angiography alone. The adjusted hazard ratio for MACE with dual IVI and IP was 0.87 (95% CI, 0.85-0.89; P < 0.0001), representing a 13% relative risk reduction.The combined use of intravascular imaging and invasive physiology during PCI has shown a modest increase in the United States and is associated with a significantly lower rate of major adverse cardiovascular events and lower long-term health care costs compared with the use of angiography alone. These findings support the use of comprehensive strategies for PCI guidance.Reference:Medina, F. A., Mosarla, R. C., Kim, J. M., Li, S., Song, Y., Yeh, R. W., & Secemsky, E. A. (2026). Adjunctive imaging and physiology during percutaneous coronary intervention: Trends, outcomes, and costs among medicare beneficiaries. JACC. Cardiovascular Interventions, 19(1), 15–27. https://doi.org/10.1016/j.jcin.2025.09.047