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

This study assessed the temporal trend in intracoronary imaging (ICI)-guided percutaneous coronary intervention (PCI) concurrent with the implementation of a statewide quality improvement initiative to increase ICI use.

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium implemented a formal initiative to increase ICI use for PCI optimization in the state of Michigan between 2020 and 2023. The initiative included focused education for physicians, reporting of comparative institution-level ICI use, and tracking of ICI use as a performance metric. The primary measure of interest was the use of ICI to optimize PCI. A hierarchical Bayesian regression model was created to assess the increase in ICI use over time. The year in which a PCI was performed was included as a variable in the model to delineate the impact of time on the odds of ICI use.

Over the 5-year study period, a total of 140,739 PCIs were performed at 48 nonfederal hospitals in Michigan and represented the study population. A progressive and significant increase in ICI use to optimize PCI was observed from 7.3% in the first year to 44.0% in the fifth year of the study (P < .001 for trend). Significant increases in ICI use were observed for all key subgroups including PCI in left main disease (19.3% to 78.5%; P < .001), stent thrombosis (13.6% to 61.4%; P < .001), and in-stent restenosis (8.7% to 50.6%; P < .001). Each 1-year increase in time was associated with a significant increase in ICI use (adjusted odds ratio, 1.98; 95% credible interval, 1.95-2.00).

Concurrent with a statewide quality improvement initiative, a significant increase in ICI use to optimize PCI was observed among patients undergoing PCI in the state of Michigan.