Regional Variation in Procedural and Clinical Outcomes Among Patients With ST Elevation Myocardial Infarction With...

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Limited data exists on regional disparities in ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS) in the United States.
• Understanding these variations is crucial for improving patient care and outcomes nationwide.

Purpose of the Study:

• To investigate geographic variations in patient characteristics, treatment strategies, and clinical outcomes for STEMI patients with CS across the four major US regions.
• To identify regional differences in percutaneous coronary intervention (PCI), mechanical circulatory support use, and associated costs.

Main Methods:

• Utilized the National Inpatient Sample database from 2006-2015.
• Identified adult patients with STEMI and CS using ICD-9-DM codes.
• Compared patient demographics, procedural outcomes, clinical outcomes, length of stay, and hospital costs across Northeast, Midwest, South, and West US regions.

Main Results:

• A total of 186,316 patients were analyzed.
• In-hospital mortality showed a non-significant trend towards higher rates in the Northeast (37.7%).
• Percutaneous coronary intervention rates were highest in the Midwest (68.5%) and lowest in the Northeast (56%).
• Mechanical support device (PVAD/ECMO) use was highest in the Northeast (3.3%/2.2%).
• Median hospital costs were highest in the West ($36,614) and lowest in the South ($28,795).

Conclusions:

• Significant geographic variations in practice patterns, healthcare costs, and in-hospital outcomes exist for STEMI patients with CS across US regions.
• These findings highlight the need for targeted interventions to address regional disparities in STEMI CS management.
• Further research is warranted to understand the drivers of these regional differences and optimize care delivery.