title: Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.
abstract: OBJECTIVE
  Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy.
  
  
  RESULTS
  Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups.
  
  
  CONCLUSIONS
  Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes.
authors.affiliation: Sharp Healthcare, San Diego, California.|San Diego Cardiac Center, San Diego, California.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Jaski
authors.affiliation: Sharp Healthcare, San Diego, California.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Grigoriadis
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Xuming
authors.initials: X
authors.lastname: Dai
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Meredith
authors.affiliation: Sharp Healthcare, San Diego, California.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Ortiz
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
authors.affiliation: Sharp Healthcare, San Diego, California.
authors.forename: Lorie
authors.initials: L
authors.lastname: Thomas
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D004608:Eligibility Determination / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome