title: Increasing percutaneous coronary interventions for ST-segment elevation myocardial infarction in the United States: progress and opportunity.
abstract: OBJECTIVE
  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. In-hospital 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.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: Rashmee.Shah@utah.edu.
authors.forename: Rashmee U
authors.initials: RU
authors.lastname: Shah
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rutten-Ramos
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Mourad
authors.initials: M
authors.lastname: Tighiouart
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: acute myocardial infarction; outcomes assessment; percutaneous coronary intervention