Abstract 12835: Predictors of Utilization of Multi-Vessel Percutaneous Coronary Revascularization vs. Bypass Surgery in Patients Hospitalized With Non-ST Wave Elevation Myocardial Infarction and Comorbid End-Stage Renal Disease: A Nationwide Analysis

Abstract

Introduction: The appropriate strategy for revascularization in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) is unknown. The aim of this study was to determine the hospital and patient levels predictors of the type of revascularization strategy pursued in patients hospitalized with non-ST wave elevation myocardial infarction (NSTEMI) and ESRD. Methods: Study cohorts were derived from the Nationwide Inpatient Sample (NIS) 2016-19. Study variables were identified using ICD-10-CM-codes. Patients presenting with cardiogenic shock were excluded. The primary outcomes were the predictors of the type of revascularization strategy pursued. Multivariable logistic regression was used to adjust for potential confounders. Results: There were a total of 87,800 hospitalizations for NSTEMI with comorbid ESRD, out of which 8060 (53%) underwent multi-vessel PCI and 6909 (46%) underwent CABG. Patients undergoing CABG were younger, had a lower proportion of females, and higher burden of comorbidities (including arrhythmias, coagulopathy, valvular heart disease, morbid obesity, and active drug abuse disorder) than those undergoing MvPCI. Multivariate patient-level and hospital-level predictors are demonstrated in Figure 1. As expected, CABG was associated with significantly higher odds of in-hospital mortality (OR:2.01 (1.3-3.1), p<0.01), length of stay (8.9 days longer, p<0.01), and total hospitalization charges (152,527$ higher, p<0.01) as compared to MvPCI. There was no difference in the odds of stroke between both cohorts. Conclusion: Patient-level factors (including female gender, age, comorbidities (arrhythmias, peripheral vascular disease, diabetes, coagulopathy, history of CABG or PCI, prior stroke/TIA), and hospital levels factors (bed size, hospital procedural volume) independently predicted the type of revascularization strategy pursued in patients hospitalized for NSTEMI with ESRD.