Increasing percutaneous coronary interventions for ST-segment elevation myocardial infarction in the United States: Progress and opportunity

Rashmee U. Shah, Timothy D. Henry, Stephanie Rutten-Ramos, Ross F. Garberich, Mourad Tighiouart, C. Noel Bairey Merz

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

OBJECTIVES: The aim of this study was to quantify changes in percutaneous coronary intervention (PCI) and mortality rates for ST-segment elevation myocardial infarction (STEMI), and the proportion of hospitals providing STEMI-related PCI in the United States. BACKGROUND: Health care systems have recently emphasized rapid access to PCI for STEMI, but the effects of these efforts in a broad population are unknown. METHODS: We used the Nationwide Inpatient Sample, a discharge database representative of all short-term, nonfederal hospitals in the United States. STEMI discharges were included based on primary discharge diagnosis. We calculated the adjusted odds ratio (OR) of PCI and in-hospital death over time and the changing proportion of hospitals providing STEMI-related PCI. RESULTS: From 2003 to 2011, STEMI accounted for 380,254 hospital discharges. The rate of PCI increased from 53.6% to 80.0% with an adjusted OR of 4.16 (95% confidence interval [CI]: 3.71 to 4.66) in 2011 compared with 2003. The proportion of hospitals providing STEMI-related PCI increased from 25.1% in 2003 to 33.7% in 2011. Inhospital death rates ranged from 7.2% to 9.5%, with the lowest rate in 2009. The OR of death decreased from 2003 to 2011 (adjusted OR: 0.79 in 2011 compared with 2003; 95% CI: 0.74 to 0.84). After accounting for PCI, the OR of in-hospital death did not change between 2003 and 2011 (adjusted OR: 1.01 in 2011 compared with 2003; 95% CI: 0.95 to 1.07). CONCLUSIONS: PCI rates and hospitals providing STEMI-related PCI increased from 2003 to 2011, whereas in-hospital death rates decreased. PCI was an important mediator of decreasing mortality in this nationally representative sample.

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Acute myocardial infarction
  • Outcomes assessment
  • Percutaneous coronary intervention

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