Maitri Pancholy

Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction

Lack of health insurance is associated with adverse clinical outcomes; however, association between health insurance status and outcomes in patients presenting with ST-elevation myocardial infarction (STEMI) is unclear. Using the Nationwide Inpatient Sample data from 2003 to 2014, hospitalizations with STEMI in patients 18 years of age and older were extracted. Based on health insurance status, patients were categorized into insured and uninsured groups. The primary outcome measure was in-hospital mortality. Adjusted analysis using inverse probability weighting with multivariable regression was performed to identify independent predictors of in-hospital mortality. Of 2,710,375 patients included in the final analysis, 220,770 patients were uninsured. Unadjusted in-hospital mortality was lower in uninsured patients (5.1% vs 9.3%; p <0.001). Adjusted analysis showed that lack of health insurance was associated with the worst in-hospital mortality (odds ratio [OR] = 1.77, 95% confidence interval [CI] 1.72 to 1.82; p <0.001). Other independent predictors of in-hospital mortality were low household income (OR = 1.08, 95% CI 1.07 to 1.09; p <0.001), acute stroke (OR = 2.87, 95% CI 2.80 to 2.95; p <0.001), acute kidney injury (OR = 2.60, 95% CI 2.57 to 2.64; p <0.001), cardiac arrest (OR = 8.88, 95% CI 8.77 to 8.99; p <0.001), cardiogenic shock (OR = 5.81, 95% CI 5.74 to 5.88; p <0.001), requirement of pericardiocentesis (OR = 10.54, 95% CI 9.64 to 11.52; p <0.001), gastrointestinal bleeding (OR = 1.41, 95% CI 1.38 to 1.54; p <0.001), and pneumonia (OR = 1.43, 95% CI 1.41 to 1.45; p <0.001). The multivariate model demonstrated good statistical discrimination (c-statistic = 0.89). In conclusion, lack of health insurance is independently associated with increased in-hospital mortality in patients presenting with STEMI.

CAN NON-PROCEDURAL PATIENT CHARACTERISTICS PREDICT IN-HOSPITAL COMPLICATIONS FOLLOWING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION? IMPLICATIONS FOR SAME-DAY DISCHARGE

Objectives: To identify non-procedural predictors of in-hospital complications following elective percutaneous coronary interventions (PCIs). Methods: Using the Nationwide Inpatient Sample (NIS) data from 1998-2013, we identified patients 18 years of age and older who were electively admitted for PCI. Post-PCI complications were defined as the occurrence of any of the following: acute cerebrovascular accident, acute kidney injury, vascular complications and blood transfusion, iatrogenic cardiac complications, cardiogenic shock, cardiac arrest or in-hospital mortality. Post-PCI same-day discharges (SDDs) were identified. Binary logistic regression was used to identify the independent predictors of post-PCI complications. Receiver Operating Characteristic (ROC)-derived Area under the Curve (AUC) was used to determine the discriminatory power of the model. Results: We identified 373,223 patients who were electively admitted for PCI as the index procedure. 18,430 patients (4.9%) developed post-PCI complications. Several covariates showed a statistically significant association with post-PCI complications [(O.R., 95% CI, P-value), age (1.009, 1.007-1.010, 0.0005), female sex (1.465, 1.421-1.511, 0.0005), hypertension (1.172, 1.094-1.255, 0.0005), congestive heart failure (1.139, 1.080-1.200, 0.0005), diabetes with end-organ damage (1.145, 1.057-1.241, 0.001), atrial fibrillation (1.515, 1.437-1.596, 0.0005), atrial flutter (1.438, 1.215-1.701, 0.0005), morbid obesity (1.216, 1.089-1.358, 0.001), chronic kidney disease (1.099, 1.008-1.199, 0.032) and Charlson comorbidity index (1.229, 1.216-1.244, 0.0005)], although the model was a poorfit with suboptimal discriminatory power (ROC-derived AUC=0.6). Conclusion: Non-procedural variables lack the ability to predict short-term adverse outcomes following elective PCI and probably should not be used in decision-making for SDD following PCI.

TEMPORAL TREND OF INCIDENCE OF STENT THROMBOSIS AND IN-HOSPITAL MORTALITY: RESULTS FROM A NATIONAL REAL-WORLD REGISTRY

Background: Stent thrombosis (ST) is a catastrophic complication with poor outcomes. Temporal trends of the incidence, substrate characteristics and outcomes of stent thrombosis in a real world population are largely unknown. Methods: The Nationwide Inpatient Sample (NIS) files from 1998 to 2013