Percutaneous coronary intervention, comorbidities, and mortality among emergency department-admitted ST-elevation
Elizabeth Barnett Pathak1, Joel A Strom
1Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida 33612, USA. epathak@health.usf.edu
Insights
Prompt percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) significantly reduces mortality risk. Same-day PCI demonstrated a strong protective effect, lowering in-hospital deaths and supporting guideline recommendations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition with high mortality risk.
- Prompt percutaneous coronary intervention (PCI) is the guideline-recommended treatment for STEMI.
- This study investigates same-day PCI's impact on in-hospital mortality using surveillance data.
Purpose of the Study:
- To determine if same-day PCI is an independent predictor of in-hospital mortality in STEMI patients.
- To analyze the association between timely PCI and survival outcomes.
- To evaluate the influence of patient factors and hospital characteristics on STEMI mortality.
Main Methods:
- Analysis of hospital discharge data for 43,849 adult STEMI patients admitted via emergency departments (2001-2005).
- Utilized hierarchical (multilevel) logistic regression models for statistical analysis.
- Adjusted for comorbidities, patient factors, and hospital PCI volume.
Main Results:
- In-hospital mortality was 9.4% overall (4,143 deaths).
- Same-day PCI patients had significantly lower mortality (1.9%) compared to those without (13.0%).
- Same-day PCI was a strong predictor of survival (adjusted OR = 0.35), with hospital volume not significantly impacting risk.
Conclusions:
- Same-day PCI significantly reduces in-hospital mortality risk for STEMI patients.
- Comorbidities, older age, and female gender remain independent predictors of mortality.
- Findings support national guidelines advocating for aggressive, timely STEMI treatment.
Background:
Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for STEMI. In this study, we examined same-day PCI as an independent predictor of in-hospital mortality, after adjustment for comorbidities, other patient factors, and hospital PCI-volume using unselected surveillance data from Florida.
Methods:
We analyzed hospital discharge data for adults, 18+ years old, with a primary diagnosis of STEMI who were admitted to PCI-capable hospitals through the emergency department during 2001-2005 (n = 43,849). Hierarchical (multilevel) logistic regression models were used for analysis.
Results:
Overall, 4,143 STEMI patients (9.4%) did not survive to hospital discharge. In late 2005, the in-hospital mortality rates were 1.9% for those who received same-day PCI versus 13.0% for those who did not. After adjustment for multiple patient factors, same-day PCI was a significant predictor of in-hospital survival with a strong protective effect (adjusted OR = 0.35, 95% CI 0.31-0.38 P < 0.0001). Restriction of the analysis to those patients who survived the first day of admission did not appreciably change this result (adjust OR = 0.37, 95% CI 0.33-0.42, P < 0.0001). Hospital PCI-volume did not significantly impact mortality risk.
Conclusions:
Same-day PCI markedly reduced the risk of in-hospital mortality among STEMI patients after multivariate adjustment. Serious comorbidities and complications, older age, and female gender continued to predict elevated risk of mortality after control for treatment status. Our results provide additional evidence in support of national clinical recommendations and aggressive treatment of STEMI.
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