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Increasing percutaneous coronary interventions for ST-segment elevation myocardial infarction in the United States:
Rashmee U Shah1, Timothy D Henry2, Stephanie Rutten-Ramos
1University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) increased significantly from 2003-2011. This rise in PCI, along with more hospitals offering it, contributed to a decrease in STEMI patient mortality.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Healthcare systems emphasize rapid percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
- The population-level impact of these initiatives on PCI rates and outcomes remains largely unknown.
Purpose of the Study:
- To quantify trends in PCI utilization for STEMI.
- To assess changes in in-hospital mortality rates for STEMI patients.
- To determine the evolving proportion of U.S. hospitals providing STEMI-related PCI.
Main Methods:
- Utilized the Nationwide Inpatient Sample (NIS) database (2003-2011).
- Included STEMI discharges based on primary diagnosis.
- Calculated adjusted odds ratios (OR) for PCI, in-hospital death, and hospital-level STEMI PCI provision.
Main Results:
- STEMI PCI rates rose from 53.6% to 80.0% (adjusted OR 4.16).
- The proportion of hospitals offering STEMI PCI increased from 25.1% to 33.7%.
- In-hospital mortality decreased, with PCI being a key factor (OR 0.79), though not the sole driver after adjustment.
Conclusions:
- PCI utilization and hospital capacity for STEMI treatment expanded significantly between 2003 and 2011.
- In-hospital mortality rates for STEMI declined during this period.
- Percutaneous coronary intervention played a crucial role in reducing STEMI-related mortality in the U.S.
Objectives:
The aim of this study was to quantify changes in percutaneous coronary intervention (PCI) and mortality rates for ST-segment elevation myocardial infarction (STEMI), and the proportion of hospitals providing STEMI-related PCI in the United States.
Background:
Health care systems have recently emphasized rapid access to PCI for STEMI, but the effects of these efforts in a broad population are unknown.
Methods:
We used the Nationwide Inpatient Sample, a discharge database representative of all short-term, nonfederal hospitals in the United States. STEMI discharges were included based on primary discharge diagnosis. We calculated the adjusted odds ratio (OR) of PCI and in-hospital death over time and the changing proportion of hospitals providing STEMI-related PCI.
Results:
From 2003 to 2011, STEMI accounted for 380,254 hospital discharges. The rate of PCI increased from 53.6% to 80.0% with an adjusted OR of 4.16 (95% confidence interval [CI]: 3.71 to 4.66) in 2011 compared with 2003. The proportion of hospitals providing STEMI-related PCI increased from 25.1% in 2003 to 33.7% in 2011. In-hospital death rates ranged from 7.2% to 9.5%, with the lowest rate in 2009. The OR of death decreased from 2003 to 2011 (adjusted OR: 0.79 in 2011 compared with 2003; 95% CI: 0.74 to 0.84). After accounting for PCI, the OR of in-hospital death did not change between 2003 and 2011 (adjusted OR: 1.01 in 2011 compared with 2003; 95% CI: 0.95 to 1.07).
Conclusions:
PCI rates and hospitals providing STEMI-related PCI increased from 2003 to 2011, whereas in-hospital death rates decreased. PCI was an important mediator of decreasing mortality in this nationally representative sample.
