Disparities in use of same-day percutaneous coronary intervention for patients with ST-elevation myocardial infarction in Florida, 2001-2005

Primary percutaneous coronary intervention (PCI) is the recommended treatment for ST-elevation myocardial infarction (STEMI), according to American College of Cardiology and American Heart Association guidelines published in 1999 and 2004. In this study, hospital and patient predictors of same-day primary PCI use for STEMI were examined across the period from 2001 to 2005. Inpatient discharge data for adults aged > or =18 years with primary diagnoses of STEMI who were admitted to Florida hospitals through emergency departments (ED) from 2001 to 2005 (n = 58,308) were analyzed. Hierarchical (multilevel) logistic regression models were used to assess hospital PCI volume and individual characteristics as predictors of same-day PCI use for patients at PCI-capable hospitals. The percentage of ED-admitted patients with a STEMI who received same-day PCI in Florida increased from 20% in early 2001 to 43% in late 2005. At PCI-capable hospitals, 50% of these patients received same-day PCI in late 2005. Patients admitted on weekends, women, patients aged > or = 75 years, patients with chronic obstructive pulmonary disease, and patients with end-stage renal disease were all significantly less likely to receive same-day PCI. Black patients were less likely to receive same-day PCI in early 2001 (adjusted odds ratio [OR] 0.7, 95% confidence interval 0.5 to 0.9, p <0.0001), but this racial disparity was not evident by late 2005 (adjusted OR 1.0). Men were more likely than women to receive same-day PCI, with a significant association remaining in late 2005 (adjusted OR 1.2, 95% confidence interval 1.1 to 1.4, p <0.0001). Throughout the study period, the strongest predictor of same-day PCI was admission to a high- or medium-volume PCI-capable hospital; the adjusted OR in late 2005 was 4.6 (95% confidence interval 2.8 to 7.6, p <0.0001). In conclusion, weekend admission, female gender, older age, and serious co-morbidities were all significant barriers to receiving same-day PCI. Among patients admitted to PCI-capable hospitals, total PCI volume (high or medium vs low) was associated with significantly greater odds of receiving primary PCI, independent of patient sociodemographics, risk factors, or co-morbidities. Statewide, despite an increase in the use of PCI over time, most ED-admitted patients with a STEMI in Florida did not receive primary PCI in late 2005.