The Scale of Variability

Even when strong evidence exists, uptake can be inconsistent. For example, intravascular imaging (IVI) has a Class I/A indication in both the USA and Europe. Yet its use varies dramatically:

·       14% in the USA

·       25% in the UK

·       90% in Japan

Zooming in on the UK, where the national average is 25%, there’s still striking local variation—ranging from 50% in London to just 9% in Manchester. Looking across all procedures, imaging is used in only 9.2% of cases overall.
(Source: BCIS/NICOR Audit 2023)

What Drives the Differences?

Data suggests that the doctor, their judgment, mindset, and approach, has the largest impact. The median odds ratio of imaging use for a patient at one site compared to another is:

·       Unadjusted: 4.6%

·       Procedural factors: 4.6%

·       Patient factors: 4.5%

·       Hospital factors: 4.5%

(Source: Malik AO et al., JACC: Advances, 2023 Jul; 2(4): 100973)

All these influences are roughly equal. The outlier is the decision-making process of the physician.

Quality decisions rely on two things:

1. The quality of information available (e.g., clear imaging, clinical context)

2. The cognitive state of the doctor - which can be affected by stress, fatigue, or the fast-paced cath lab environment.

In other words, effective PCI requires both thinking and doing.

The Optima Approach

At Optima, we believe that planning reduces variability and improves decision-making. By creating informed strategies, considering plaque characteristics, angiographic data, physiology, and patient goals, clinicians can approach each PCI with clarity and confidence.

We want to empower practitioners to make better decisions, aligned with both evidence and patient needs, ensuring consistent quality of care regardless of where or by whom the procedure is performed.