19-LB: The Impact of Diabetes on 30-Day Readmission, In-Hospital Mortality, and Medical Cost in ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention—A Nationwide Readmissions Database Analysis

Abstract

Background: ST-elevation myocardial infarction (STEMI) poses significant morbidity, mortality and economic burden in people with diabetes. We sought to determine the impact of diabetes on the short-term outcome and hospital costs post-percutaneous coronary intervention (PCI) for STEMI. Methods: STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. From the patients who underwent PCI, we examined the 30-day readmission, in-hospital mortality, and total cost according to the presence of diabetes, prior stroke, and prior MI. All statistical analyses were performed using R statistical software version 4.1.2. Results: Among 539,171 index STEMI hospitalizations for primary PCI, 10.1% were readmitted within 30 days and 4.6% died in hospital. The readmission rates were 10.2%, 12.9%, 14.4%, 17.5%, and 18.4% in the reference (i.e., no diabetes, prior MI or stroke) , diabetes-only, diabetes and MI, diabetes and stroke, diabetes, MI, and stroke groups, respectively (P<0.001) . The corresponding adjusted hazard ratios for 30-day readmission were 1.14 (95% CI 1.10-1.18) , 1.23 (1.12-1.35) , 1.24 (1.10-1.39) , and 1.29 (0.99-1.68) . In-hospital mortality rates during index hospitalization were 4.3%, 5.3%, 5.5%, 7.2%, and 7.4% in the reference, diabetes-only, diabetes and MI, diabetes and stroke, diabetes, MI, and stroke groups, respectively (P<0.001) . The corresponding adjusted odds ratios for mortality were 1.24 (95% CI 1.15-1.33) , 1.55 (1.28-1.87) , 1.51 (1.22-1.87) , and 2.03 (1.27-3.25) . The median overall cost increased by 4.5% and 11.8% in the diabetes-only group and diabetes, MI, and stroke group, respectively, compared with the reference group (P<0.001) . Conclusion: Within 30 days of PCI for STEMI, diabetes increases readmission rate, in-hospital mortality, and financial burden with and without prior CVD. These findings underscore the importance of aggressive optimization in STEMI patients with diabetes. Disclosure Y. Kang: None. S. Jang: None.