Abstract 6235: Outcomes Among Patients with Non-ST-Segment Elevation Myocardial Infarction Presenting to Interventional Hospitals With and Without On-Site Cardiac Surgery: A NRMI 5 Analysis
Background: The efficacy and safety of cardiac catheterization and percutaneous coronary intervention (PCI) at hospitals without open heart surgery (No-OHS hospitals) among patients with non-ST-segment elevation myocardial infarction (NSTEMI) is an area of active investigation.
Methods: The National Registry of Myocardial Infarction enrolled 100,071 NSTEMI patients at 214 OHS and 52 No-OHS hospitals with PCI capability from 2004–2006. The incidence of in-hospital mortality, the administration of guideline-recommended medications and the use of PCI were evaluated in the overall cohort and again in a case-control analysis matching for baseline patient characteristics.
Results: In-hospital mortality was significantly lower among patients presenting to OHS hospitals (5.0% vs. 8.8% p<0.001). Patients presenting to OHS hospitals were significantly more likely to receive antiplatelet agents, beta-blockers and statins within 24 hours of admission and at discharge (p<0.001 for all). Patients presenting to OHS hospitals were more likely to undergo elective PCI (38.4% vs. 14.1%, p<0.001). In the propensity-matched case-control analysis, patients presenting to OHS hospitals had significantly lower mortality (5.9% vs. 8.5%, p<0.001) and were more likely to receive antiplatelet agents, beta-blockers and statins (all p<0.001). However, after adjusting for differences in medications within 24 hours and hospital characteristics, the difference in mortality was attenuated (HR 1.08, 95% CI 0.90–1.29, p=0.41). In addition, when the case-control analysis was further restricted solely to patients undergoing elective PCI, there was no significant difference in mortality (1.3% vs. 1.0%, p=0.49).
Conclusions: In a large case-control analysis of real-world data, there was no difference in mortality among NSTEMI patients undergoing PCI at No-OHS and OHS hospitals. The substantially higher mortality observed among all patients (PCI and non-PCI) presenting to No-OHS appears to be largely explained by both hospital characteristics and compliance with guideline-recommended therapies in the first 24 hours.