Intracoronary Imaging to Guide PCI in Acute Coronary Syndromes: A Report From the BMC2 Registry

BACKGROUND: Intracoronary imaging (ICI) to guide percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) carries a Class I recommendation in US guidelines. AIMS: This analysis evaluated the frequency of ICI use among patients with ACS. METHODS: Using data from a large statewide registry, all patients undergoing PCI between January 1, 2019, and December 31, 2024, were studied. The primary measure of interest for this analysis was the use of ICI to guide PCI, defined as the use of ICI after the decision was made to proceed with PCI. The frequency of ICI use among patients with and without ACS was compared, and the trend in ICI use in ACS patients over the study period was examined. RESULTS: During the 6-year study period, 166,238 PCIs were performed at 51 non-federal hospitals in Michigan, of which 90,441 (54.4%) were performed for ACS. ICI was used to guide PCI in 25,234 (27.9%) ACS cases, which was significantly lower than ICI use in 23,999 (31.7%) non-ACS cases (p < 0.001). Over the 6-year study, a progressive and significant increase in ICI use in ACS was observed from 6.5% in the first year to 54.4% in the sixth year of the study (p < 0.001 for trend). CONCLUSIONS: Despite its proven benefits in ACS, ICI was used to guide PCI significantly less often among patients presenting with ACS compared with those without ACS. However, the ICI to guide PCI in ACS has increased significantly over time and at a similar pace compared to those without ACS.