Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial
Brian E Jaski1,2, Christopher E Grigoriadis1, Xuming Dai3
1Sharp Healthcare, San Diego, California.
Insights
Inpatient ST-elevation myocardial infarction (STEMI) patients face higher mortality and lower PCI use due to bleeding risks and complex disease. Developing specific protocols for inpatients may improve outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-elevation myocardial infarction (STEMI) requires timely revascularization for optimal outcomes.
- Understanding reasons for percutaneous coronary intervention (PCI) ineligibility is crucial for improving STEMI care.
- Differences in PCI access and outcomes between inpatient and outpatient STEMI populations are not well-defined.
Purpose of the Study:
- To compare factors and outcomes associated with PCI ineligibility in inpatient versus outpatient STEMI patients.
- To identify the primary reasons for PCI denial in these distinct patient groups.
- To inform the development of targeted strategies for improving STEMI management.
Main Methods:
- Retrospective cohort study of 1,759 STEMI patients (June 2009 - January 2015).
- Review of individual medical records to determine reasons for PCI ineligibility.
- Comparison of demographic, clinical, and procedural data between inpatient and outpatient groups.
Main Results:
- Inpatients (n=71) received less coronary angiography (60.6%) and PCI (50.7%) compared to outpatients (n=1,688; 95.9% and 80.9%, respectively).
- Inpatients experienced longer ECG/door-to-device times (97 vs 63 minutes).
- Primary contraindications were bleeding risk (inpatients) and complex coronary artery disease (outpatients), with higher in-hospital mortality in inpatients (42.2% vs 10.0%).
Conclusions:
- PCI ineligibility reasons and outcomes differ significantly between inpatient and outpatient STEMI.
- Inpatients face greater risks of bleeding, reduced PCI utilization, and increased mortality.
- Implementing specialized STEMI protocols for inpatients is essential to address ineligibility factors and improve survival rates.
Objectives:
Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI).
Methods:
A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy.
Results:
Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups.
Conclusions:
Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes.
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