The UK Intracoronary Imaging Survey: Evaluation of Perceptions, Barriers, Education and Training.

BACKGROUND: This national survey evaluated awareness of indications and perceived barriers to the application of intracoronary imaging (ICI) among physicians and cath lab allied health professionals (AHP) in the UK. METHODS: A web-based questionnaire consisting of 35 questions, covering operator and institutional demographics, physician-based indications for ICI, physician confidence-competence and barriers to ICI use, was distributed to 974 physicians (consultant and trainee operators) and 713 AHPs via the British Cardiovascular Intervention Society. For statistical analyses, a two-sided p<0.05 was considered statistically significant. RESULTS: In all, 327 physicians (including 30% of practising UK consultants) and 125 AHPs responded. The greatest response was observed in early career operators (uptake 38% versus 7% for those with ≤5 years versus >20 years' experience, respectively). There was a preference for intravascular ultrasound (IVUS) over optical coherence tomography (OCT; 74% versus 26%, respectively). Strongest indications for ICI use by lesion aetiology were left main percutaneous coronary intervention (97.7%), stent failure (96.5%), procedural optimisation (92.6%) and calcific disease (89.8%). Operators reported OCT superiority in the identification of stent failure and plaque rupture, and IVUS superiority in ostial and left main disease, spontaneous coronary dissection and chronic total occlusion interventions. Core barriers to ICI application were procedural turnover (65.4%), lack of training and education (61.8%) and the absence of consultant-level proctorship (56.1%). A mismatch between operator-reported confidence in device use and competency in image interpretation across lesion aetiologies was identified, with 58.9% and 57.7% of operators expressing a desire to actively upskill and increase appropriate ICI usage, respectively. CONCLUSION: This first UK national survey on ICI highlights important barriers to the application of ICI in routine clinical practice. These data should stimulate a paradigm shift in collaborative widespread national training and education strategies for ICI in the UK.