Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial
Ashwin S Nathan1,2, Kevin F Kennedy3, Kriyana P Reddy1
1University of Pennsylvania Philadelphia PA USA.
Insights
Variability exists in percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI). Over 3.5% of STEMI patients with culprit lesions did not receive PCI, with some hospitals exceeding 5% non-treatment rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Percutaneous coronary intervention (PCI) is a key treatment for ST-segment-elevation myocardial infarction (STEMI).
- There is potential variability in PCI utilization for higher-risk STEMI patients.
- Understanding treatment patterns and hospital-level variations is crucial for optimizing care.
Purpose of the Study:
- To describe current treatment selection patterns for STEMI patients with culprit lesions.
- To identify and quantify hospital-level variability in PCI utilization for STEMI.
- To analyze patient characteristics associated with not undergoing PCI.
Main Methods:
- Utilized the National Cardiovascular Data Registry (NCDR) Chest Pain-Myocardial Infarction (CPMI) registry.
- Included 178,984 STEMI patients from 582 US hospitals between January 1, 2019, and March 31, 2023.
- Compared patient characteristics and outcomes for those who did and did not undergo PCI.
Main Results:
- Overall, 3.5% (6,180 patients) of STEMI patients with a culprit lesion did not undergo PCI.
- Patients not receiving PCI were older, more likely to have heart failure, and had a higher incidence of cardiac arrest prior to arrival.
- Non-PCI patients exhibited significantly higher predicted and observed mortality rates compared to those who received PCI.
Conclusions:
- Significant variability exists in PCI rates for STEMI patients with culprit lesions across US hospitals.
- Approximately a quarter of US hospitals reported >5% of STEMI patients not undergoing PCI.
- Discrepancies between observed and predicted mortality may suggest risk-avoidant treatment behaviors in some cases.
Background:
There may be variability in willingness to perform percutaneous coronary intervention (PCI) in higher-risk patients who present with ST-segment-elevation myocardial infarction (STEMI). We sought to describe current treatment selection patterns and hospital-level variability.
Methods And Results:
We identified patients presenting with STEMI with a culprit lesion on coronary angiography between January 1, 2019, and March 31, 2023, using the NCDR (National Cardiovascular Data Registry) CPMI (Chest Pain-Myocardial Infarction) registry. We compared patient-level characteristics of patients who did and did not undergo PCI at each hospital. There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. Among patients with STEMI and a culprit lesion, 6180 did not undergo PCI (3.5%). Patients with a presentation of STEMI and a culprit lesion who did not undergo PCI were older (67 [interquartile range, 58-76]) years versus 62 ([interquartile range, 54-71] years, P<0.001), more likely to present with heart failure (15.0% versus 7.4%, P<0.001), and more likely to have cardiac arrest before arrival (9.7% versus 5.1%, P<0.001) than patients who underwent PCI. Patients who did not undergo PCI had higher predicted mortality rates (12.5%±17.9% versus 6.5%±11.5%, P<0.001) and observed mortality rates (21.7% versus 6.4%, P<0.001) compared with patients who underwent PCI.
Conclusions:
There is variability in the percentage of patients with culprit lesions on invasive coronary angiography undergoing PCI for STEMI, with 3.5% of patients with STEMI not receiving PCI overall, and >5% of patients not undergoing PCI in a quarter of US hospitals. Differences in observed versus predicted mortality rates for patients who did or did not undergo PCI may highlight the effects of risk-avoidant behavior.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care