Association Between Intracoronary Imaging During PCI and Clinical Outcomes in a Real-World US Medicare Population

•500,000 PCI procedures analyzed from 2015 to 2020 using Medicare claims data.•92% of US PCIs performed with angiography alone•7.5% of PCIs were IVUS-guided and <1% OCT-guided•Propensity score matching used to compare 3-year outcomes after angiography-, IVUS-, or OCT-guided PCI.•Risk of MACE was similar for IVUS but lower for OCT compared to angiography alone.