Abstract 19058: STEMI Patients Presenting to Non PCI Capable Hospitals in New York State: Treatment Strategies and 30-Day Mortality
Background: Most of what is known about patients (pts) with STEMI is derived from the minority of hospitals voluntary reporting in national registries, primarily those undergoing PCI. Less is known about the treatment and outcomes of STEMI pts presenting to non-PCI hospitals.
Objectives: To identify the relative frequencies with which STEMI pts present to NYS hospitals with and without on-site PCI, the frequency of transfer for PCI (or CABG), and 30-day mortality rates from 1/1/13-12/31/14 utilizing the Statewide Planning and Research Cooperative System (SPARCS) mandatory registry.
Methods: Pts identified as having a STEMI based on a principal diagnosis of 410.x1 were analyzed, excluding out-of-state pts (3.7%, N=513). Vital status at 30 days was confirmed via vital statistics data.
Results: 13,901 STEMI pts were admitted to NYS hospitals in the 2-year period who met the inclusion criteria, representing 25% of admissions with a 1o diagnosis of AMI. Of these, 77% were directly admitted to 1 of NYS’s 62 PCI hospitals, 20% were admitted to 1 of NYS’s 173 non-PCI hospitals and transferred to a PCI hospital, and 3% were admitted to a non-PCI hospital without subsequent transfer. Mortality was 9.2% (987/10697) for pts admitted directly to PCI hospitals vs 12.1% (384/3174; p<0.001) for those admitted to non-PCI hospitals (7.9% for pts transferred and 39% for pts not transferred). The overall frequency of revascularization was 84% for pts directly admitted to PCI hospitals vs 73% for those admitted to non-PCI hospitals; 95% of pts revascularized underwent PCI.
Conclusions: In 2013-14 in NYS, 25% of pts with a 1o diagnosis of MI were coded as having a STEMI; 23% of STEMI pts presented to a hospital that could not perform PCI. The mortality of such pts was higher (12.1%) than those presenting at a PCI hospital (9.2%), entirely driven by the mortality rate of pts not transferred to a hospital capable of performing revascularization (39%). The reasons for the difference in treatment and outcomes for STEMI patients admitted to non PCI hospitals require further study.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention (PCI)
- Quality of medical care
- Quality improvement
Author Disclosures: A.K. Jacobs: None. P. Berger: None. G.D. Walford: None. Y. Wu: None. E.L. Hannan: None.
- © 2016 by American Heart Association, Inc.