title: Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012]).
abstract: The primary objective of our study was to evaluate the in-hospital outcomes in terms of mortality, procedural complications, hospitalization costs, and length of stay (LOS) after multivessel percutaneous coronary intervention (MVPCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, years 2006 to 2012. Percutaneous coronary interventions (PCI) performed during STEMI were identified using appropriate International Classification of Diseases, Ninth Revision, diagnostic and procedural codes. Patients in cardiogenic shock were excluded. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables such as in-hospital mortality and composite of in-hospital mortality and complications, and hierarchical mixed-effects linear regression models were used for continuous dependent variables such as cost of hospitalization and LOS. We identified 106,317 (weighted n = 525,161) single-vessel PCI and 15,282 (weighted n = 74,543) MVPCIs. MVPCI (odds ratio, 95% confidence interval [CI], p value) was not associated with significant increase in in-hospital mortality (0.99, 0.85 to 1.15, 0.863) but predicted a higher composite end point of in-hospital mortality and postprocedural complications (1.09, 1.02 to 1.17, 0.013) compared to single-vessel PCI. MVPCI was also predictive of longer LOS (LOS +0.19 days, 95% CI +0.14 to +0.23 days, p <0.001) and higher hospitalization costs (cost +$4,445, 95% CI +$4,128 to +$4,762, p <0.001). MVPCI performed during STEMI in hemodynamically stable patients is associated with no increase in in-hospital mortality but a higher rate of postprocedural complications and longer LOS and greater hospitalization costs compared to single-vessel PCI.
authors: Cardiology Department, Borgess Medical Center, Kalamazoo, Michigan.
authors: Sidakpal S
authors: SS
authors: Panaich
authors: Cardiology Department, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York.
authors: Shilpkumar
authors: S
authors: Arora
authors: Cardiology Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors: Nilay
authors: N
authors: Patel
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Theodore
authors: T
authors: Schreiber
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Nileshkumar J
authors: NJ
authors: Patel
authors: Cardiology Department, Staten Island University Hospital, Staten Island, New York.
authors: Bhavi
authors: B
authors: Pandya
authors: Cardiology Department, Borgess Medical Center, Kalamazoo, Michigan.
authors: Vishal
authors: V
authors: Gupta
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Cindy L
authors: CL
authors: Grines
authors: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors: Abhishek
authors: A
authors: Deshmukh
authors: Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com.
authors: Apurva O
authors: AO
authors: Badheka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007674:Kidney Diseases / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D011655:Pulmonary Embolism / Q000191:economics / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000191:economics / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000191:economics / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000191:economics / Q000453:epidemiology; D055815:Young Adult