In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock at Safety-Net Hospitals in the United States; Analysis of the Nationwide Inpatient Sample

Ando, Tomo

In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock at Safety-Net Hospitals in the United States; Analysis of the Nationwide Inpatient Sample

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Tomo Ando, M.D. , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Emmanuel Akintoye, MD, MPH , Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa city, IA

Oluwole Adegbala, MD, MPH , Englewood Hospital and Medical Center, Englewood, NJ

Said Ashraf, MD , Wayne State University - Detroit Medical Center, Detroit, MI

Mohamed Shokr, MD , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Hisato Takagi, MD, PhD , Shizuoka Medical Center, Shizuoka, Japan

Cindy L. Grines, M.D., MSCAI , ., New York, NY

Luis Afonso, MD , Wayne State University/Detroit Medical Center Program/Harper University, 3990 John R St, MI

Alexandros Briasoulis, MD, PhD , University of Iowa Hospitals and Clinics, Iowa, IA

Background
Safety-net hospitals (SNH) are hospitals that serve a higher proportion of patients insured by Medicaid or uninsured and have been reported to have poor outcomes compared to non-SNHs. Procedural and clinical outcomes of ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) at SNHs has not been well described.

Methods
Nationwide inpatient sample from 2005-2011 was queried to identify those with STEMI-CS and age ≥18. SNHs were defined as hospitals with the top quartile of inpatient stays that were paid by Medicaid or were uinsured. Adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to compare clinical outcomes between the hospitals.

Results
A total of 23,229 STEMI-CS of which 3,639 (15.6%) were treated at SNHs. Admissions to SNHs were younger (66.0 vs. 67.2, p<0.001), more likely male (64.0% vs. 62.2%, p=0.04), ethnic minorities (Black; 11.0% vs. 6.0%, Hispanic 20.4% vs. 5.8%, p<0.001), and had higher Elixhauser ≥4 (25.8% vs. 21.9%, p<0.001). Percutaneous coronary intervention (PCI) (60.4% vs. 65.8%, p<0.001) were less performed whereas thrombolysis (2.9% vs. 2.1%, respectively, p=0.001) was more frequent at SNHs. In-hospital mortality was significantly elevated at SNHs (36.6% vs. 32.7, aOR 1.23, 95%CI 1.09-1.38) while new dialysis, stroke, and fatal arrhythmias were similar. The median length of stay was similar (6 vs. 7 days, p=0.57) but the median cost was higher (40,175 vs. 38,012 dollars, p=0.01).

Conclusions
SNHs had lower utilization of PCI and higher in-hospital mortality compared with non-SNH in STEMI-CS. Further cause analysis is warranted to improve outcomes of STEMI-CS admitted at SNHs.