Abstract 4138225: In-Hospital Outcomes of Percutaneous Coronary Intervention (PCI) in patients primarily admitted with ST-Elevation Myocardial Infarction (STEMI) at PCI centers versus patients transferred from non-PCI centers, a retrospective study involving the National Inpatient Sample (NIS 2016-2021) database.

Abstract

Background: Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study's aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center. Methods: The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications. Results: Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 - 0.81 days, p-value <0.000) and $3,354 (95% CI: $339 - $6371, p-value <0.029), respectively. Patients transferred also had significantly higher odds of post procedure complications, including cardiogenic shock (Odds ratio: 1.49, 95% CI: 1.08 - 2.06, p-value <0.014), cerebrovascular accident (Odds ratio: 3.64 , 95% CI: 1.15 - 11.45, p-value <0.014) and kidney failure (Odds ratio: 2.10 , 95% CI: 1.09 - 4.02, p-value <0.026). Conclusion: Patients with STEMI who were transferred for PCI experienced longer hospital stay and incurred higher healthcare costs. These patients had significantly higher odds of post procedure complications including cardiogenic shock, cerebrovascular accidents and kidney failure.