{
  "abstract": "Introduction Contemporary percutaneous coronary intervention (PCI) is increasingly shaped by rising anatomical and procedural complexity. This is defined and driven by the expanding treatment of heavily calcified lesions, multivessel disease, and bifurcation anatomy, alongside broader adoption of potent antithrombotics and stent-sparing technologies. However, current metrics inadequately characterise how modern PCI increasingly concentrates complexity, resource utilisation, and operator expertise within individual procedures and catheter laboratories. To address this gap, we derived and validated a composite Tech Intensity Index, a standardised model quantifying the simultaneous uptake of complex PCI, potent antiplatelet therapy, and drug-coated balloon (DCB) use as an integrated marker of contemporary interventional practice at a national level.Methods This study used publicly available national procedural data from the National Institute for Cardiovascular Outcomes Research (NICOR) National Audit of Percutaneous Coronary Interventions (NAPCI) Annual Summary Reports, capturing PCI activity across England and Wales (2019/20-2024/20). Technical intensity was proxied by three a priori domains: (1) complex PCI procedure rates; (2) potent P2Y12 inhibitor prescription in acute coronary syndromes; and (3) DCB utilisation for in-stent restenosis. Annual raw percentages were standardised into Z-scores and summed to derive the Tech Intensity Index. Temporal trends and correlations between individual domains and the composite index were assessed to evaluate diffusion patterns.Results Across the six-year period, sustained growth was observed in all three domains of technical intensity. The proportion of complex PCI increased by an absolute 16.2% (15.9% to 32.1%). Use of potent P2Y12 inhibitors rose by 13.0% (44.0% to 57.0%). DCB utilisation for in-stent restenosis demonstrated the steepest adoption, increasing six-fold with an absolute rise of 36.1% (7.4% to 43.5%) ( figure 1). The Tech Intensity Index rose in parallel and demonstrated a strong correlation with year-on-year diffusion of advanced techniques (R2 > 0.9), supporting its construct validity as an integrated measure of contemporary PCI practice (figure 2).Conclusion This Tech Intensity Index offers a pragmatic approach to quantify the evolving technical demands of modern PCI beyond procedural volume alone. By integrating measures of lesion complexity, pharmacological intensity, and stent-sparing technology adoption, the index captures the uptake of advanced practice over time. The temporal rise in technical intensity highlights a sustained shift towards more resource-intensive PCI, with potential implications for workforce planning, training, and service configuration within cardiac networks. Despite reliance on national-level aggregate data with only three intensity domains, this study establishes a framework for future longitudinal studies quantifying the evolving technological capabilities in interventional cardiology.Abstract 164 Figure 1Co-diffusion of advanced interventional techniques (2019–2020). Comparative analysis of the uptake rates for three distinct domains of interventional practice over six financial years. The trends demonstrate the simultaneous expansion of Complex PCI volume (defined by calcification, multi-vessel, or bifurcation disease), the increasing prescription of potent P2Y12 inhibitors in acute coronary syndromes, and the rapid diffusion of Drug-Coated Balloon therapy for In-Stent Restenosis. Abbreviations: DEB – Drug-eluting balloon, ICI – Intracoronary imaging, PCI – Percutaneous coronary imagingAbstract 164 Figure 2Longitudinal evolution of the ’tech intensity index’. The ’tech intensity index’ is a novel composite metric calculated by aggregating the Z-scores (standardised deviations) of the three technical domains relative to the 2019/20 baseline. The graph illustrates the steady year-on-year accumulation of procedural complexity, validating the index as a robust, single-number marker for tracking the technical intensity of the catheterisation laboratory workload",
  "authors": [
    {
      "affiliations": [
        "Faculty of Medicine, University College London, London, UK"
      ],
      "name": "Abhinav Kandala"
    },
    {
      "affiliations": [
        "Faculty of Medicine, King’s College London, London, UK"
      ],
      "name": "Sukruth Pradeep Kundur"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA",
        "Department of Surgery and Cancer, Imperial College London, London, UK"
      ],
      "name": "Amar Rai"
    }
  ],
  "title": "164 The tech intensity index: a composite metric for tracking procedural complexity and device adoption in interventional cardiology",
  "uid": "6d9a935a-232e-518f-a3eb-75cff025ec34"
}