Clinical and Economic Burden Following Percutaneous Coronary Intervention for STEMI: A US Real-World Evidence Study

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Economics

Background:

• ST-segment-elevation myocardial infarction (STEMI) impacts 250,000 individuals annually in the U.S., leading to significant morbidity and mortality.
• One-year outcomes after percutaneous coronary intervention (PCI) for STEMI demonstrate variability across existing studies.

Purpose of the Study:

• To assess clinical and economic outcomes in STEMI patients following PCI.
• To identify risk factors associated with adverse clinical outcomes and increased healthcare costs post-PCI for STEMI.

Main Methods:

• Analysis of adult STEMI patients undergoing PCI between 2016-2021 using the Premier Healthcare Database.
• Assessment of clinical outcomes, healthcare resource utilization, and costs for at least one year post-PCI, with a 3-year follow-up subset.
• Application of multivariable regression models (Cox, logistic, generalized linear) to determine risk factors for key outcomes.

Main Results:

• 180,691 STEMI patients underwent PCI; median age 62, 71% male, 62.7% non-Hispanic White, 42.9% Medicare primary payor.
• Index visit mortality was 5.5%; within 1 year, additional deaths were 1.1%, readmissions 17.4%, heart failure (HF) 13.4%, heart failure hospitalization (HHF) 2.5%, atrial fibrillation 3.9%, recurrent STEMI 1%.
• A Charlson Comorbidity Index (CCI) score of ≥4 was strongly associated with increased 1-year mortality (HR: 4.1), readmissions (OR: 2.6), HHF (OR: 4.1), and 74% higher costs.

Conclusions:

• Identified key risk factors impacting one-year clinical outcomes and costs following PCI for STEMI.
• Highlights the significant impact of comorbidities on STEMI patient outcomes and resource utilization post-PCI.