Mortality rate of percutaneous coronary interventions in st-segment elevation myocardial infarction patients under the public health insurance schemes of thailand

Abstract

Abstract Background ST-elevation myocardial infarction (STEMI) presents a critical public health challenge internationally, including in Thailand. Currently, standard therapeutic interventions, particularly primary percutaneous coronary interventions (pPCI), are administered to Thai citizens. However, selected healthcare systems restrict access to specific pharmaceuticals and medical devices, causing inequalities in the quality of medical care amongst different healthcare systems. Such inequalities have the potential to significantly impact the quality of life of patients, particularly in the long term. Purpose The primary objective is to compare mortality rates within one year of STEMI patients after treatment with pPCI among the public health insurance schemes of Thailand. The secondary objective is to study prognostic determinants for one-year mortality rates among patients diagnosed with STEMI who have undergone pPCI. Methodology This study is a single-centre retrospective analysis of patients with STEMI treated with pPCI. It involves patients utilising various state health insurance schemes in Thailand from 1 January 2010 to 31 December 2020. Data collection occurred through the hospital's computerised management system and the registration administration office of the Department of Provincial Administration. The data analysis employed the Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazards regression modelling method. Results The study involved 1,077 patients, categorised into three groups based on their state health insurance: Universal Health Coverage (UC) (546 patients, 50.7%), Social Security System (SS) (199 patients, 18.5%), and Civil Service Reimbursement (CS) (332 patients, 62.6%). The one-year mortality rates in these groups were 10.57%, 4.21%, and 6.47%, respectively (p=0.010). In the unadjusted model, the SS group showed a lower risk of one-year mortality rate (HR 0.38, 95% CI 0.18-0.80, p=0.011), and the CS group also demonstrated a lower risk (HR 0.59, 95% CI 0.35-0.99, p=0.047) compared to the UC group. In the adjusted model, only the CS group significantly reduced the risk of one-year mortality. Other factors that affected one-year mortality were age ≥65 years, a Killip score of 3-4, pre-discharge prescription of angiotensin-converting enzyme inhibitors, occlusion in the left anterior descending artery, and pericardial effusion. Conclusion Healthcare schemes play a significant role in influencing one-year mortality rates among STEMI patients treated with pPCI. The use of civil service reimbursement is a protective factor for the one-year mortality rate in STEMI patients. This information would be crucial for developing strategies and programs to aid healthcare policymakers at both regional and international levels in reducing morbidity and mortality.