Abstract 14352: Variations in Spontaneous Coronary Artery Dissection Diagnosis Based Upon Hospital Status

Abstract

Background: Spontaneous coronary artery dissection (SCAD) contributes to a significant number of acute coronary syndrome (ACS) in middle-aged female. SCAD data are accumulating to understand its epidemiology, etiology, presentation, and diagnosis. Despite the rising incidence, there is limited data regarding the number of diagnosed cases based on hospital location. We hypothesized that more cases of SCAD are diagnosed at teaching urban hospitals than urban non-teaching or rural hospitals. Methods: In this retrospective study, the discharge data were extracted from the National Inpatient Sample (NIS), and Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 2010 to 2017. We used the 9th and the 10th revisions of International Classification Disease (ICD-9-CM code 414.12, ICD-10-CM Code I25. 42) for SCAD. SCAD cases per year (weighted to represent nation sample) were collected and stratified by hospital location (urban teaching, urban non-teaching, and rural). p - value was calculated by Cochran-Armitage test. A p -value of <0.05 was considered significant and all p-values were two-sided. Results: We found a total of 490 patients with a primary diagnosis of SCAD. The numbers were weighted to present a national total of 2432 discharges. Demographic characteristics are shown in table-1. Year-year SCAD cases quantified by rural, urban teaching, urban non-teaching status are shown in table-1. Of these 2432 discharges, 72.34% were at the urban teaching hospitals, followed by 25.05% at urban non-teaching hospitals, and only 2.6% were at rural hospitals. This difference was statistically significant (p -value <0.001). Conclusions: A higher number of SCAD cases at urban teaching hospitals may indicate the diagnosis bias due to better availability of expertise and advanced modalities to diagnose this entity at urban teaching hospitals.