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Clinical and Economic Burden Following Percutaneous Coronary Intervention for STEMI: A US Real-World Evidence Study
Shanthi Krishnaswami1, Brendan Clark2, Manu Tyagi1
1Premier Applied Sciences, Premier Inc, Charlotte, NC, USA.
Insights
High comorbidity scores in ST-segment-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) significantly increase mortality, hospital readmissions, and healthcare costs within one year post-procedure.
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.
Introduction:
ST-segment-elevation myocardial infarction (STEMI) affects approximately 250,000 people in the U.S. annually, causing substantial morbidity and mortality. One-year outcomes following percutaneous coronary intervention (PCI) for STEMI vary across studies.
Aim:
To assess clinical and economic outcomes following PCI among patients with STEMI.
Methods:
This study analyzed adult patients with STEMI undergoing PCI between 2016 and 2021, using Premier Healthcare Database and additional mortality and claims data. Clinical outcomes, healthcare resource use, and costs following first PCI discharge (index visit) were assessed for at least 1 year, with outcomes at 3-year follow-up assessed among a subset of patients. Multivariable regression (Cox, logistic or generalized linear) was used to identify risk factors for key outcomes.
Results:
A total of 180,691 patients underwent PCI for STEMI in 633 US hospitals during the study period. The median age was 62 years, most were male (71%), non-Hispanic White (62.7%), and had Medicare as the primary payor (42.9%). At index visit, 13.8% had ventricular tachycardia, 8.8% had ventricular fibrillation, with a median cost of $17,582, and a mortality rate of 5.5%. Within 1 year, there were 1,966 (1.1%) additional deaths, 17.4% were readmitted, 13.4% developed heart failure (HF), 2.5% were hospitalized primarily for HF (HHF), 3.9% had atrial fibrillation, and 1% experienced recurrent STEMI. The median total study cost by 1 year was $21,010. A Charlson Comorbidity Index (CCI) score of ≥4 (vs <4) at index visit was most strongly associated with higher risk of death at 1 year: hazard ratio: 4.1, (95% CI: 3.66 to 4.49), higher odds of readmissions (OR: 2.6, 95% CI: 2.50 to 2.70), HHF (OR: 4.1 (95% CI: 3.83 to 4.42)), and 74% higher costs (p<0.05). Similar associations were observed at 3-year follow-up (n=59,714).
Conclusion:
This study identified risk factors associated with one-year negative clinical outcomes and increased cost following PCI for the treatment of STEMI.
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