A-43 | Influence of Hospital Location on Outcomes in ST-Segment Myocardial Infarction Among Patients Hospitalized for Non-Cardiac Indications

Abstract

ST-segment elevation myocardial infarction (STEMI) in patients hospitalized for non-cardiac indications carries a high mortality rate. The impact of hospital location on inpatient STEMI (IPS) outcomes is not well understood. We queried the New York Statewide Planning and Research Cooperative System database for all STEMI claims from 2011 to 2018 using validated ICD-9 and ICD-10 codes and classified these as outpatient STEMI (OPS) if present on admission or IPS if not present on admission. A CDC classification scheme determined by hospital Federal Information Processing Series (FIPS) code was used to stratify hospitals as urban, suburban, or rural. Comparisons were made between urban, suburban and rural hospitals among patients with IPS. A total of 61,646 STEMI patients were identified from 231 hospitals, of which 3428 (5.6%) were classified as IPS. Consistent with prior studies, IPS patients were older (72.1 ± 13.3 years vs 63.8 ± 13.7 years; p < .0001), more frequently female (46.7% vs 31.7%; p < .0001), less likely to receive percutaneous coronary intervention (PCI) (23.7% vs 74.4%; p < .0001), had more comorbidities, and had higher 30-day (43.6% vs 10.4%; p < .0001) and 1-year (53.3% vs 14.8%; p < .0001) mortality compared to OPS. IPS constituted a higher percentage of all STEMIs in rural hospitals (10.1%) than in suburban (4.4%) or urban hospitals (5.7%). IPS patients in rural hospitals, compared to suburban and urban hospitals, had a higher overall 30-day (56.2% vs 45.9% vs 42.3%) and 1-year (65.2% vs 55.2% vs 52.1) mortality and were less likely to receive PCI (10.7% vs 30.0% vs 23.3%) (p < 0.0001). Without PCI, IPS patient 30-day and 1-year mortality was also higher at rural hospitals compared to suburban or urban hospitals (30-day: 59.1% vs 57.8% vs 50.6%; 1-year: 69.2% vs 66.9% vs 61.0%; p < 0.01). IPS patients who received PCI had similar 30-day and 1-year mortality regardless of hospital location. IPS constituted a higher percentage of STEMI patients and was associated with higher 30-day and 1-year mortality in rural hospitals compared to suburban and urban hospitals. PCI was associated with better outcomes in IPS and was less frequently used in IPS patients in rural compared to suburban and urban hospitals.