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.
Bibliographical noteFunding Information:
Dr. Bairey-Merz is supported by NHLBI contracts N01-HV-68161 , N01-HV-68162 , N01-HV-68163 , and N01-HV-68164 ; grants U0164829 , U01 HL649141 , U01 HL649241 , T32HL69751 , HL090957 , and 1R03AG032631 from the NIA ; GCRC grant MO1-RR00425 from the National Center for Research Resources ; and grants from the Gustavus and Louis Pfeiffer Research Foundation , Danville, New Jersey; The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, California; The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pennsylvania; and QMED, Inc., Laurence Harbor, New Jersey; the Edythe L. Broad Women’s Heart Research Fellowship, Cedars-Sinai Medical Center; the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center; The Society for Women’s Health Research, Washington, DC; and the Linda Joy Pollin Women’s Heart Health Program, Cedars-Sinai Medical Center. These funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Shah is a stockholder in Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
© 2015 by the American College of Cardiology Foundation.
- Acute myocardial infarction
- Outcomes assessment
- Percutaneous coronary intervention