Abstract 16859: Prevalence of Mechanical Complications and Associated Mortality in Patients With ST-Segment Elevation Myocardial Infarction (STEMI) Treated With Thrombolysis (TT) Compared to Primary-PCI (P-PCI): A Nationwide Study Using National Inpatient Sample (NIS)

Abstract

Introduction: Papillary muscle rupture (PMR), ventricular septal rupture (VSR) and cardiac free wall rupture (FWR), are dreaded complications of STEMI and are associated with increased morbidity and mortality. In multiple previous small to intermediate sized studies, TT as compared to P-PCI was associated with an increase in these mechanical complications. However, large scale observational studies are lacking. Methods: Adult admissions with a primary diagnosis of STEMI between 1999 and 2014 were extracted from the NIS using the ICD-9 code 410.x, except 410.7x (NSTEMI). ICD-9-CM procedure codes 36.01 to 36.07, 36.09, 00.66 and 99.10 were used to stratify the extracted data into patients who underwent P-PCI (Time-to procedure function was used to filter PCI performed within first 24 hours of presentation) and those treated with TT. The incidence of PMR (ICD-9 Code 429.6) and VSR (ICD-9 Code 429.71), VSR (ICD-9 Code 429.71) and FWR (ICD-9 Code 429.79) within 30 days of hospitalization were compared between these two groups. We performed multivariate analysis using Cox Proportional Hazard Regression to control for confounders and determine the hazard of all three complications in patients who had undergone P-PCI vs TT, and the relative mortality of these complications by reperfusion strategy. Results: Of the weighted 2,534,019 admissions for STEMIs, 1,335,711 (52.71%) underwent P-PCI whereas 125,009 (4.93%) were treated with TT. Among these, 748 (0.02%) developed PMR, 3122 (0.12%) developed VSR, and 4850 (0.19%) developed FWR. The adjusted hazard for a complication according to reperfusion modality, and the mortality by treatment are depicted below in Table 1. Conclusions: As compared with P-PCI, patient who were treated with TT had a higher risk of mechanical complications, including PMR, VSR and FWR, and a higher mortality associated with each of these complications.