Statewide Initiative to Increase Intracoronary Imaging Optimization in PCI: A Report From the BMC2 Registry

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Intracoronary imaging (ICI) guides percutaneous coronary intervention (PCI) for optimal outcomes.
• A statewide quality improvement initiative was launched in Michigan to boost ICI utilization for PCI.

Purpose of the Study:

• To assess the temporal trend of ICI use in PCI.
• To evaluate the impact of a statewide quality improvement initiative on ICI adoption.

Main Methods:

• A hierarchical Bayesian regression model analyzed ICI use trends from 2020-2023.
• Data included 140,739 PCIs across 48 Michigan hospitals.
• ICI use was tracked as a performance metric, with focused physician education and comparative reporting.

Main Results:

• ICI use for PCI optimization significantly increased from 7.3% to 44.0% over the study period (P < .001).
• Significant increases were observed across key subgroups: left main disease (19.3% to 78.5%), stent thrombosis (13.6% to 61.4%), and in-stent restenosis (8.7% to 50.6%).
• Each year of the study was associated with a near doubling of ICI use (aOR, 1.98).

Conclusions:

• A statewide quality improvement initiative effectively increased ICI use for PCI optimization in Michigan.
• The findings demonstrate successful implementation of a strategy to enhance guideline-adherent cardiovascular care.