Regional variation across the United States in management and outcomes of ST-elevation myocardial infarction: analysis of the 2003 to 2010 nationwide inpatient sample database.
BACKGROUND
Regional differences in the treatment and outcomes of patients with ST-elevation myocardial infarction (STEMI) within the United States remain poorly understood.


OBJECTIVE
Treatment choice and outcomes in patients with STEMI differ between regions within the United States.


METHODS
We used the 2003 to 2010 Nationwide Inpatient Sample databases to identify all patients age ≥ 40 years hospitalized with STEMI. Patients were divided into 4 groups according to region: Northeast, Midwest, South, and West. Multivariable logistic regression was used to identify differences in treatment choice and outcomes (in-hospital mortality, acute stroke, and cardiogenic shock) among the 4 regions.


RESULTS
Of 1,990,486 patients age ≥ 40 years with STEMI, 350,073 (17.6%) were hospitalized in the Northeast, 483,323 (24.3%) in the Midwest, 784,869 (39.4%) in the South, and 372,222 (18.7%) in the West. Compared with the Northeast, patients in the Midwest, South, and West were less likely to receive medical therapy alone and more likely to receive percutaneous coronary intervention and coronary artery bypass grafting. Risk-adjusted in-hospital mortality was higher in the Midwest (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.05-1.09, P <0.001), South (OR: 1.03, 95% CI: 1.01-1.05, P = 0.001), and West (OR: 1.06, 95% CI: 1.04-1.08, P <0.001), as compared with the Northeast. When adjusted further for regional variation in treatment selection, risk-adjusted in-hospital mortality was even higher in the Midwest, West, and South.


CONCLUSIONS
Despite higher reperfusion and revascularization rates, STEMI patients in the Midwest, West, and South have paradoxically higher risk-adjusted in-hospital mortality as compared with patients in the Northeast.
Department of Medicine, New York Medical College, Valhalla, New York.
Dhaval
D
Kolte
Sahil
S
Khera
Wilbert S
WS
Aronow
Marjan
M
Mujib
Chandrasekar
C
Palaniswamy
Ali
A
Ahmed
William H
WH
Frishman
Gregg C
GC
Fonarow
D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology