Hello, I'm Sunil Rao from NYU Langone Health System. I was president of SCI during the 2022-2023 year, and I'm really thrilled to be able to introduce this new initiative, a collaboration between SCAI and MedAxiom, titled Intravascular Imaging to Improve PCI Performance and Outcomes. This is supported by an unrestricted educational grant from Abbott Basket. This is really about changing practice to improve outcomes in the cath lab, and the focus of this particular campaign is to increase the implementation and adoption of intracoronary imaging. We know that the uptake of intracoronary imaging is relatively low in the United States right now, despite the fact that there are multiple studies, including randomized trials, showing improved outcomes, both short- and long-term, for patients. So the purpose of this particular campaign is to get people to adopt intracoronary imaging and also proliferate best practices as it relates to intracoronary imaging to improve outcomes. I want to start with a little bit of a personal story of how I actually evolved my practice to incorporate intracoronary imaging, and then we'll talk about the details of the program as it relates to this campaign. So the first thing that we realized in my practice was that we really needed to adopt intracoronary imaging because the data supported it. I'm not going to get into the data here because that will be the focus of some of the resources that will be available on the SCI website. But because of the randomized trials showing improved outcomes in PCI, we collectively as a group decided that we needed to incorporate intracoronary imaging into our practice. The first step in doing that is making sure that you have the appropriate equipment. And now there are several imaging platforms available. What I'm showing you on the slide is OCT. There are obviously several intravascular ultrasound platforms available, both low-definition and high-definition, but we believe that it's really, really important to make sure that you have the right equipment, you have the availability of the catheters, you've got a working system as part of the first step in order to incorporate that imaging. In this particular case, I'm showing you a case of a patient who had a proximal LAD lesion and this patient underwent OCT-guided PCI with co-registration. And that's another important aspect of how to incorporate intracoronary imaging into your practice is the integration of the imaging platform with your angiogram so you know exactly where to start and stop your stent, as well as understanding what the diameters of these vessels are so you can get adequate expansion of your stent and adequate apposition. This is done for you with some platforms that are automatically integrated with the angiogram and that's called co-registration and other platforms where it's not currently available but will be in the near future. Either way, having that imaging and incorporating it with your clinical judgment and the angiogram is really key to making sure that you get the best outcomes. This is the growth of intracoronary imaging at our institution. This is my prior institution. It's very similar to what happened at the institution I'm currently at, where the imaging rates were very, very low and used only in selected cases. But really, once the data really started to emerge that it was important for outcomes, we adopted intracoronary imaging as a group and the adoption rate is now above 75%. It's hard to get national use data on intracoronary imaging. What we do know is that it's still relatively low. It's somewhere in the 10% to 15% range, but the slope is very, very steep and I suspect that similar to the adoption of radial access, that intracoronary imaging will be adopted increasingly in the future, particularly as fellows who are training to use imaging as part of their PCI practice are going out into clinical practice. How can SCI help? We think that SCI can facilitate the contributors to the adoption, first by disseminating the data that shows clearly better short and long-term outcomes with intracoronary imaging, especially in complex lesions. Certainly on the off part of the cath labs, it's important to admit what you don't know and resolve to learn and use SCI as a resource. I already talked about the integration of imaging into the workflow and the importance of technology, but really where the rubber meets the road is with education and training, which is clearly where SCI and MedAxiom can make a difference, and then consistency, which is using the intracoronary imaging on every single case, even if it's not a complex PCI so that it gets integrated into your workflow, you get used to interpreting the imaging, and then using that data to make decisions when you choose your stent diameter, length, as well as lesion prep strategies like atherectomy or IVL, and then post-dilation. The SCI campaign for intracoronary imaging or intravascular imaging is really to raise awareness of the effectiveness of IVI in improving multiple cardiovascular endpoints, and really to call attention to the fact that there's underperformance or underadoption of IVI in the United States, and that may lead to some of our poor patient outcomes compared to other global regions, for example, Southeast Asia, where the IVI rates are close to 100% and they have the lowest rates of stent thrombosis in the world. The way we are going to do that, we meaning SCI and MedAxiom, is to provide tools to help cath labs adopt intracoronary imaging. So there's going to be technical guidance on the application of imaging for periprocedural PCI for optimal stent placement and expansion, and then also practical guidance on acquisition and deployment of imaging modalities into diverse interventional settings. We know that not all cath labs are affiliated with the training program. We know that many cath labs are incredibly high volume and throughput is incredibly important and efficiency is important. And so practical guidance on how to incorporate IVI into all those different settings is going to be one of the major goals of this campaign. What SCI does really, really well is to provide a clinician education and resources through SCI meetings as well as online platforms, such as webinars, imaging cases, and tips of the month. I'll go through some of those resources for you. MedAxiom, their expertise is in implementation. They are working with SCI to co-develop content with a focus on operational implementation. They are very, very good and are experts at understanding the local challenges in each cath lab and understanding what the local resources are. But they also will offer resources to the cath lab team to help develop workflows, maintain competencies and understand how images are stored and the technical limitations that may be at each site. They will work with operational leadership to optimize supply chain and make sure that imaging catheters are continually available. They'll optimize contracting and also help to work with sites to make sure that the finances are in the site's favor. And then, of course, making sure that we're capturing the coding appropriately so that billing can take place and demonstrating that return on investment. So let me take you through some of the SCI resources. This is the SCI website, and if you click under resources here, you'll see that there is a section called online courses. This is really where all of the IVI resources will be maintained on the SCI website. If you click on that online courses link, you'll be taken to the online learning center where there's really a whole host of resources for you. What's being shown for you here is just the expert consensus statement on the management of calcified coronary lesions. This in fact is one coronary lesion subset where intravascular imaging really does make a difference. But you also see that there are other resources available for you. So for example, resources on the future of coronary imaging and physiology. What role does physiology and imaging have in coronary interventions? How can you optimize intravascular imaging for peripheral interventions, for example? There's an imaging workshop link, the introduction to intravascular imaging for fellows in training or for those people who, like me, were really naive to how to interpret some of these intravascular imaging images. And then there's an entire set of cases, for example, on physiology. What's shown for you here is the physiology guided complex PCI. So this online learning center is going to be the hub for all of the IVI resources that you're going to need to make sure that you implement IVI in your own practice. There will be courses in all clinical interest areas. There are 12 new imaging and physiology courses that are housed on the SCI website. You can easily access these and look at these on your own time. They're going to be updated each month. And if you're a member of SCI or a fellow of SCI, this is completely free for you. So again, I encourage you to go to the SCI website and click on these resources and understand what's there for you. Again, these are going to be updated every month with the latest data, with tips and tricks on how you can implement IVI in your own practice. So in summary, intravascular imaging is essential to good PCI outcomes. This SCI MedAxium partnership will provide resources to implement and integrate IVI into your own clinical practice. The content is dynamic. It will reflect the latest data and the latest best practices. And I want to remind all of you that SCI wants you. Please become a member or a fellow of SCI to keep up with the latest in coronary imaging and with interventional cardiology and have an opportunity to contribute to the profession. So thank you again, and I look forward to working with all of you on the intravascular imaging initiative.

Sunil Rao

SCAI

MedAxiom

intravascular imaging

PCI outcomes