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Utilization Rate and Outcomes of Intravascular Imaging in Elderly Patients Presenting With ST-Elevation Myocardial
Mohammed Elzeneini1, Omkar Betageri2, Sujay R Kamisetty3
1Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America.
Insights
Intravascular imaging use in ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) is linked to reduced in-hospital deaths for all ages. Lower utilization in elderly STEMI patients warrants further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Elderly patients with ST-elevation myocardial infarction (STEMI) are a high-risk group due to comorbidities and complex coronary anatomy.
- Percutaneous coronary intervention (PCI) is a common treatment for STEMI, but outcomes can vary.
- The role of intravascular imaging in guiding PCI for elderly STEMI patients is not well-defined.
Purpose of the Study:
- To determine the utilization rate of intravascular imaging in elderly patients undergoing PCI for STEMI.
- To compare the outcomes of PCI with and without intravascular imaging in elderly STEMI patients.
- To analyze the association between intravascular imaging use and in-hospital mortality and readmission rates.
Main Methods:
- Analysis of the Nationwide Readmissions Database (2018-2019) for STEMI hospitalizations involving PCI.
- Stratification of patients into younger (<75 years) and older (≥75 years) cohorts.
- Propensity score-weighted regression analysis to assess the impact of intravascular imaging on mortality and readmission.
Main Results:
- Intravascular imaging was used less frequently in older patients (6.8%) compared to younger patients (7.8%).
- Use of intravascular imaging was associated with significantly lower in-hospital mortality in both younger (OR 0.60) and older (OR 0.61) cohorts.
- No significant difference in 90-day all-cause readmission or MI-specific readmission was observed with intravascular imaging use.
Conclusions:
- Intravascular imaging during STEMI PCI is associated with reduced in-hospital mortality across all age groups.
- Further research is needed to address the underutilization of intravascular imaging in elderly STEMI patients.
- Optimizing intravascular imaging use may improve outcomes for vulnerable elderly populations undergoing PCI.
Background:
Elderly patients presenting with ST-elevation myocardial infarction (STEMI) represent a vulnerable population with comorbid conditions and complex coronary anatomy. We aimed to describe the utilization rate and outcomes of intravascular imaging to guide percutaneous coronary intervention (PCI) in this population.
Methods:
The Nationwide Readmissions Database was queried for all hospitalizations for STEMI involving PCI from 2018 to 2019. Hospitalizations were stratified by patient age into a younger cohort <75 years (mean age 58.7 ± 9.5 years) and an older cohort ≥75 years. Propensity score-weighed regression analysis was used to identify the association of intravascular imaging with in-hospital mortality, 90-day all-cause readmission, and readmission for myocardial infarction (MI).
Results:
A total of 299,619 STEMI PCI hospitalizations were included. Intravascular imaging was utilized less frequently in the older cohort (6.8 % vs 7.8 %, odds ratio [OR] 0.87, 95 % CI 0.82-0.92, p < 0.001). In both cohorts, intravascular imaging was more likely to be used with anterior STEMI, complex PCI, mechanical support, and thrombectomy. Propensity score analysis showed the use of intravascular imaging was associated with lower in-hospital mortality in both cohorts (OR 0.60, 95 % CI 0.52-0.68, p < 0.001 in the younger cohort and OR 0.61, 95 % CI 0.51-0.72, p < 0.001 in the older cohort). There was no difference in 90-day all-cause readmission or readmission for MI with intravascular imaging.
Conclusions:
Intravascular imaging during STEMI PCI is associated with lower in-hospital mortality regardless of age. Further studies are needed to understand the low utilization rates especially among elderly patients.
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