Cardiac Catheterization Rates Research Articles

Women With Breast Implants Have a Higher Adjusted Rate of Cardiac Catheterization but a Lower Rate of Percutaneous Coronary Intervention Consistent With Suspected Higher False-Positive Rates of Cardiac Stress Imaging Due to Breast Implant Interference

Women With Breast Implants Have a Higher Adjusted Rate of Cardiac Catheterization but a Lower Rate of Percutaneous Coronary Intervention Consistent With Suspected Higher False-Positive Rates of Cardiac Stress Imaging Due to Breast Implant Interference

Evaluating the Rates of Mortality and Cardiac Catheterization Using High-Sensitivity Troponin and Conventional Troponin Assays.

Non-ST segment elevation myocardial infarction (NSTEMI) is an acute coronary syndrome event where myocardial ischemia is present, with an increase of cardiac troponins without an elevation of the ST segment.One of the fundamental measures used to diagnose or rule out acute coronary syndrome (ACS) is troponin levels in the blood.Troponin is a broad term used for the category of muscle contraction regulatory proteins and is commonly measured during ACS evaluation. Troponin I is only released by cardiac tissue, while some assay measurements will also pick up troponin released by skeletal muscle injury. This retrospective observational study was performed investigating troponin assays and how they relate to patient's outcomes. The troponin assays used in this Miami hospital where the database of patients was collected between 2018 and 2023 were troponin I (cTnI), the conventional troponin assay, and the newer high-sensitivity troponin I assay (hs-cTn). In this observational study patients who received an admitting diagnosis of NSTEMI corroborated by an independent cardiologist had their respective troponin assay levels included. Patients found to have ECG changes significant for non-ischemic pathologies, or echocardiogram findings suggestive of myocardial dysfunction not clinically correlated to an ACS were excluded from the study. A total of 75 patients were included in this study and the mean age was 75.97 ±14.72 years, with a presentation of chest pain, dyspnea and general weakness recorded in 59% (n = 45) of patients. The median time between troponin samples was 6.63 hours across both assays and hs-cTn showed a 4.99% increase in variation between samples while cTnI had a decrease of 2.53%. The study objective is to support whether there is a difference in rates of cardiac catheterization or mortality based on the type of troponin testing. There was no significant association found between, the type of troponin assay used during hospital admission, and the outcomes of catheterization and death (p > 0.009).

Variations and inequities in access to cardiac diagnostic services in Ontario Canada

ObjectivesEchocardiography is an essential diagnostic modality known to have wide regional utilization variations. This study's objectives were to quantify regional variations and to examine the extent to which they are explained by differences in population age, sex, cardiac disease prevalence (CDP), and social determinants of health (SDH) risk. MethodsThis is an observational study of all echocardiography exams performed in Ontario in 2019/20 (n = 695,622). We measured regional variations in echocardiography crude rates and progressively standardized rates for population age, sex, CDP, and SDH risk. ResultsAfter controlling for differences in population age, sex, and CDP, Ontario's highest rate regions had echocardiography rates 57% higher than its lowest rate regions. Forty eight percent of total variation was not explained by differences in age, sex, and CDP. CDP increased with SDH risk. Access to most cardiac diagnostics was negatively correlated with SDH risk, while cardiac catheterization rates were positively correlated with SDH risk. ConclusionVariations analysis that adjusts for age and sex only without including clinical measures of need are likely to overestimate the unwarranted portion of total variation. Substantial variations persisted despite a mandatory provider accreditation policy aimed at curtailing them. The associations between variations and SDH risks imply a need to redress access and outcome inequities.

Sex-Based Disparities in Acute Myocardial Infarction Treatment Patterns and Outcomes in Older Adults Hospitalized Across 6 High-Income Countries: An Analysis From the International Health Systems Research Collaborative.

Sex differences in acute myocardial infarction treatment and outcomes are well documented, but it is unclear whether differences are consistent across countries. The objective of this study was to investigate the epidemiology, use of interventional procedures, and outcomes for older females and males hospitalized with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) in 6 diverse countries. We conducted a serial cross-sectional cohort study of 1 508 205 adults aged ≥66 years hospitalized with STEMI and NSTEMI between 2011 and 2018 in the United States, Canada, England, the Netherlands, Taiwan, and Israel using administrative data. We compared females and males within each country with respect to age-standardized hospitalization rates, rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery within 90 days of hospitalization, and 30-day age- and comorbidity-adjusted mortality. Hospitalization rates for STEMI and NSTEMI decreased between 2011 and 2018 in all countries, although the hospitalization rate ratio (rate in males/rate in females) increased in virtually all countries (eg, US STEMI ratio, 1.58:1 in 2011 and 1.73:1 in 2018; Israel NSTEMI ratio, 1.71:1 in 2011 and 2.11:1 in 2018). Rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery were lower for females than males for STEMI in all countries and years (eg, US cardiac catheterization in 2018, 88.6% for females versus 91.5% for males; Israel percutaneous coronary intervention in 2018, 76.7% for females versus 84.8% for males) with similar findings for NSTEMI. Adjusted mortality for STEMI in 2018 was higher for females than males in 5 countries (the United States, Canada, the Netherlands, Israel, and Taiwan) but lower for females than males in 5 countries for NSTEMI. We observed a larger decline in acute myocardial infarction hospitalizations for females than males between 2011 and 2018. Females were less likely to receive cardiac interventions and had higher mortality after STEMI. Sex disparities seem to transcend borders, raising questions about the underlying causes and remedies.

Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis.

Machine learning clustering offers an unbiased approach to better understand the interactions of complex social and clinical variables via integrative subphenotypes, an approach not studied in out-of-hospital cardiac arrest (OHCA). We conducted a cluster analysis for a cohort of OHCA survivors to examine the association of clinical and social factors for mortality at 1 year. We used a retrospective observational OHCA cohort identified from Medicare claims data, including area-level social determinants of health (SDOH) features and hospital-level data sets. We applied k-means clustering algorithms to identify subphenotypes of beneficiaries who had survived an OHCA and examined associations of outcomes by subphenotype. We identified 27,028 unique beneficiaries who survived to discharge after OHCA. We derived 4 distinct subphenotypes. Subphenotype 1 included a distribution of more urban, female, and Black beneficiaries with the least robust area-level SDOH measures and the highest 1-year mortality (2375/4417, 53.8%). Subphenotype 2 was characterized by a greater distribution of male, White beneficiaries and had the strongest zip code-level SDOH measures, with 1-year mortality at 49.9% (4577/9165). Subphenotype 3 had the highest rates of cardiac catheterization at 34.7% (1342/3866) and the greatest distribution with a driving distance to the index OHCA hospital from their primary residence >16.1 km at 85.4% (8179/9580); more were also discharged to a skilled nursing facility after index hospitalization. Subphenotype 4 had moderate median household income at US $51,659.50 (IQR US $41,295 to $67,081) and moderate to high median unemployment at 5.5% (IQR 4.2%-7.1%), with the lowest 1-year mortality (1207/3866, 31.2%). Joint modeling of these features demonstrated an increased hazard of death for subphenotypes 1 to 3 but not for subphenotype 4 when compared to reference. We identified 4 distinct subphenotypes with differences in outcomes by clinical and area-level SDOH features for OHCA. Further work is needed to determine if individual or other SDOH domains are specifically tied to long-term survival after OHCA.

Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries

Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Being in the top and bottom quintile of income within and across countries. Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.

Abstract 14155: Concomitant Use of Creatine Kinase MB and High-Sensitivity Troponin: What is the Cost?

Introduction: AHA/ACC guidelines recommend the use of serial high sensitivity troponin (hs-Tn) assays to assess for cardiac injury 1 and addition of CK-MB adds no benefit. However, in the clinical setting, CK-MB assays continues to be ordered concomitantly with hs-Tn in evaluation of suspected myocardial injury/infarction. We performed this study to determine whether the addition of CK-MB to hs-Tn alters diagnostic or therapeutic decisions and to determine its effect on patient outcomes. The financial aspects of this practice were also analyzed Methods: We performed a retrospective review of patients in the Geisinger Health care system from 2018 through 2021. Those having both a CK-MB and a hs-Tn drawn within 24 hours were included. Test results were categorized as concordant or discordant. Patient demographics, clinical profiles, medications and rates of diagnostic cardiac catheterization and subsequent PCI and primary admission and discharge diagnosis were collected from the EMR and analyzed. We used Medicare reimbursement data for estimates of financial impact. Results: A total of 18,727 unique patients had a CK-MB and hs-Tn performed within a 24-hour window. Of these, 49.1% (9,149) had concordant values and 50.9% (9,533) had discordant values. Of those with discordant results, 8,801 (92.3%) patients had abnormal hs-Tn result but normal CK-MB. Abnormal CK-MB with a normal hs-Tn was resulted in 840 patients (8.8%). There was a total of 42,276 CK-MB determinations during our study timeframe which averages out to 2.3 CK-MB/patient. Medicare reimbursement for CKMB is $11.55. Conclusions: This 3-year study demonstrates clinicians still frequently ordered CKMB in patients with concomitant hs-Tn determinations and 49.1%% results are concordant with hs-Tn results yielding no additional clinical information versus use of hs-Tn alone. The cost of this practice is estimated at $239,749.31 for the study period. Data on patients with discordant results and impact on decision process and cost is under analysis and will be available for presentation.

Pulmonary Hypertension in Children with Down Syndrome: Results from the Pediatric Pulmonary Hypertension Network Registry

To characterize distinct comorbidities, outcomes, and treatment patterns in children with Down syndrome and pulmonary hypertension in a large, multicenter pediatric pulmonary hypertension registry. We analyzed data from the Pediatric Pulmonary Hypertension Network (PPHNet) Registry, comparing demographic and clinical characteristics of children with Down syndrome and children without Down syndrome. We examined factors associated with pulmonary hypertension resolution and a composite outcome of pulmonary hypertension severity in the cohort with Down syndrome. Of 1475 pediatric patients with pulmonary hypertension, 158 (11%) had Down syndrome. The median age at diagnosis of pulmonary hypertension in patients with Down syndrome was 0.49year (IQR, 0.21-1.77years), similar to that in patients without Down syndrome. There was no difference in rates of cardiac catheterization and prescribed pulmonary hypertension medications in children with Down syndrome and those without Down syndrome. Comorbidities in Down syndrome included congenital heart disease (95%; repaired in 68%), sleep apnea (56%), prematurity (49%), recurrent respiratory exacerbations (35%), gastroesophageal reflux (38%), and aspiration (31%). Pulmonary hypertension resolved in 43% after 3years, associated with a diagnosis of pulmonary hypertension at age <6months (54% vs 29%; P=.002) and a pretricuspid shunt (65% vs 38%; P=.02). Five-year transplantation-free survival was 88% (95% CI, 80%-97%). Tracheostomy (hazard ratio [HR], 3.29; 95% CI, 1.61-6.69) and reflux medication use (HR, 2.08; 95% CI, 1.11-3.90) were independently associated with a composite outcome of severe pulmonary hypertension. Despite high rates of cardiac and respiratory comorbidities that influence the severity of pulmonary hypertension, children with Down syndrome-associated pulmonary hypertension generally have a survival rate similar to that of children with non-Down syndrome-associated pulmonary hypertension. Resolution of pulmonary hypertension is common but reduced in children with complicated respiratory comorbidities.

A-25 | Racial Differences in Rates of Cardiac Catheterization and Revascularization in Patients with History of Cocaine Use Admitted with Acute Coronary Syndrome

A-25 | Racial Differences in Rates of Cardiac Catheterization and Revascularization in Patients with History of Cocaine Use Admitted with Acute Coronary Syndrome

Abstract 9111: The Impact of Covid-19 Pandemic on the Treatment of Myocardial Infarction- A Single Center Experience

Introduction: The corona virus disease-2019 (COVID-19) pandemic has been associated with decrease in the rate of myocardial infarction (MI), and this is likely related to patients delaying seeking care due to COVID-19 concerns. Methods: In this retrospective observational study, we compared all patient encounters who presented with MI to Ascension Saint Agnes Hospital, Baltimore, MD from March to December 2020 with a cohort of patient encounters who presented with MI during an equivalent period in 2019. We analyzed the data using Statistical Package for Social Sciences (SPSS) and used two sample t-test and Chi-square x 2 to compare the outcomes between the two cohorts as appropriate. Results: We had 275 MI admissions that met our inclusion criteria. When comparing MI encounters in 2020 with encounters in 2019, there were no significant differences in mortality (2.1% vs. 4.5%, p=0.274), acute renal failure(14.9% vs. 18.7%, p=0.403), or intensive care unit admission (7.1% vs. 7.5%, p=0.892). There were no significant differences in modalities of treatment including cardiac catheterization (94.3% vs. 95.5%, p=0.652), or medical treatment alone (13.5% vs. 18.7%, p=0.241) in 2020 vs. 2019. Referrals for coronary artery bypass graft surgery (CABG) were significantly higher in 2020 than in 2019 (8.5% vs. 3.0%, p=0.050). When comparing patients who presented during the first 5 months of the pandemic (March-July) with patients who presented in the last 5 months of the pandemic in 2020 (August - December); there were significant decrease in rate of cardiac catheterization (90.5% vs. 98.5%, p = 0.041), and significant increase in rate of medical treatment alone (18.9% vs. 7.5%, p = 0.047) in the first 5 months. Conclusions: The first five months of the pandemic were associated with a significant decrease in rates of pursuing cardiac catheterization along with an increase rates of medical treatment alone compared with the following five months.

Racial differences in outcomes and utilization after cardiac arrest in the USA: A longitudinal study comparing different geographical regions in the USA from 2006–2018

AimHealthcare disparities can affect access and quality of care among many in the United States (US). In addition to race, we sought to assess if geography affected rates of cardiac arrest, and the subsequent outcomes. MethodsUsing the National Inpatient Sample database from 2006–2018, we assessed rates of cardiac arrest (out of hospital that survived to admission and in-hospital) and cardiac catheterization, and length of stay (LOS) in four regions: Northeast (NE), South (SO) West (W) and Midwest (MW). ResultsCardiac arrest increased from 27,611 (2006) to 43,333 (2018). The proportion of African American (AA) patients experiencing cardiac arrest significantly increased from 11.9% to 18.8%. The mortality decreased from 65.4% to 60.8% in all patients and 70.2% to 61.4% in AA. Mortality in AA remained higher than non-AA (OR, 1.09 [1.08–1.11], p < 0.001). When regions were compared for mortality, MW had a lower risk than NE 0.94[0.92–9.96]; SO 1.05[1.04–1.07] and W 1.11[1.09–1.13] were higher compared to NE. LOS decreased slightly from 9.0 days to 8.7 in all patients. LOS for AA was longer than non-AA (11.3 vs 8.6 days) with the NE having the longest LOS. AA were less likely to receive cardiac catheterization than non-AA (9.5% vs 15%) with the largest racial gap in the MW region. ConclusionThe proportion of AA with cardiac arrests increased over the study period. Mortality and LOS improved significantly in AA from 2006 to 2018 but remain significantly higher than non-AA patients. Future research should identify contributors to these concerning trends.

The Relationship between Organizational Factors and Timely Cardiac Catheterization Rate in ST-segment Elevation Myocardial Infarction Patients of Hospitals in Thailand

Introduction: This descriptive study aimed to study an association between the level of readiness of administrative factors and the timely cardiac catheterization rate of patients with acute ischemic heart disease in hospitals in Thailand.&#x0D; Materials and methods: The target population was 1,180 hospitals that serving heart disease in Thailand. Data were collected by using a questionnaire. A total of 1,022 response data were obtained. The statistics used to analyze the data were frequency, percentage, mean, standard deviation, and correlation was analyzed by multiple regression analysis. &#x0D; Results: The organizational factors, which consisted of personnel, finance, supporting, and management factors, had overall average readiness at a high level (x̄ = 3.34, S.D. = 0.27). While budget sufficiency was at a low level (x̄ = 2.43, S.D. = 0.43). All factors were significantly related to the timely cardiac catheterization rate, as follows: management factor (Adjust R2 = 0.442), personnel factor (Adjust R2 = 0.244), supporting factor (Adjust R2 = 0.212) and financial factor (Adjust R2 = 0.091). &#x0D; Conclusion: Therefore, the Thai Ministry of Public Health should provide adequate support for organizational factors, especially in terms of budget sufficiency.

THE RELATIONSHIP BETWEEN ADMINISTRATIVE FACTORS AND EFFECTIVENESS OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION REFERRAL SYSTEM AMONG THAI HOSPITALS

Background: This descriptive study aimed to study the relationship between administrative factors and the effectiveness of the referral system of patients with acute ischemic heart disease in Thai hospitals. Materials and methods: The target population was 1,180 hospitals that serving heart disease in Thailand. Data were collected by using a questionnaire. A total of 1,022 response data were obtained. Administrative factors were analyzed using descriptive statistics, and the relationship was analyzed using multiple regression analysis (MRA) methods. Results: The study showed that the administrative factors which consisted of personnel, finance, supporting, and management factors had overall average readiness at a high level (x̄ = 3.34, S.D. = 0.27). Except budget sufficiency was at a low level (x̄ = 2.43, S.D. = 0.43). All factors were related to the mortality rate significantly, as follows: management factor (Adjusted R2 = 0.433), personnel factor (Adjusted R2 = 0.231), supporting factor (Adjusted R2 = 0.092) and financial factor (Adjusted R2 = 0.035). All factors were also significantly related to the timely cardiac catheterization rate, as follows: management factor (Adjusted R2 = 0.442), personnel factor (Adjusted R2 = 0.244), supporting factor (Adjusted R2 = 0.212) and financial factor (Adjusted R2 = 0.091). Conclusion: Thai Ministry of Public Health should provide adequate support for administrative factors, especially in terms of management, personnel, supporting factors, and budget sufficiency.

Abstract 16451: The Temporal Trend in the Utilization of Noninvasive Cardiac Test for Chest Pain Evaluation and Its Impact on Cardiac Catheterization Trends

Introduction: Noninvasive diagnostic testing serves as gatekeepers to invasive cardiac catheterization. Computed tomography coronary angiogram (CTCA) has been shown to have high sensitivity and negative predictive value in the diagnosis of coronary artery disease (CAD). However, the temporal trend of CTCA compared to functional tests and the differential downstream impact on cardiac catheterization is unknown. Objective: This study aimed to investigate the temporal trend of the use in CTCA for the evaluation of patients with chest pain and how it compares to the temporal trend of stress testing. The secondary aim was to investigate the temporal pattern in the cardiac catheterization rate and how it varies between CTCA and stress testing. Methods: We performed a retrospective review of 65,686 patients who presented to a large academic medical center with chest pain between 2012 and 2019. We identified those who received CTCA testing or stress testing as the initial diagnostic testing for diagnosing suspected CAD and collected data on downstream cardiac catheterization. We calculated the testing rate per 1000 for each year. Results: Of the patient who received noninvasive imaging (n=18,843), more CTCA was performed (18.6%) compared to stress test (10.1%). After an initial upward trend in CCTA use and a downward trend in stress test use between 2012 and 2014, the trend reversed for both modalities after 2015. The rate of cardiac catheterization increased after 2014, mirroring an increase in stress test utilization. Patients who had stress test first have increased odds of undergoing catheterization compared to those who had CTCA first, even after adjusting for risk factors. However, compared to CTCA, stress test shows a relative decline in the odds of catheterization (Relative adjusted Odd Ratio: 5.6 in 2012 down to 2.8 in 2019) Conclusion: In this large single-center study of chest pain patients, stress-testing leads to increased odds of cardiac catheterization compared to CCTA. However, the relative odds of undergoing catheterization following stress testing show a declining trend.

Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease

Background: Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida. Methods: A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p&lt;0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (&lt;0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p&lt;0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p&lt;0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm 3 vs. 570 ± 342 cells/mm 3 , p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p&lt;0.05). Conclusion: In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.

Gender Disparities in Cardiac Catheterization Rates Among Emergency Department Patients With Chest Pain.

Previous studies have noted differences in rates of cardiac testing based on gender of patients. We evaluated cardiac catheterization rates for men and women presenting to the emergency department (ED) with chest pain, particularly among patients without a history of myocardial infarction (MI) or recent positive stress test. We performed a prospective evaluation of patients presenting to an urban, academic medical center for assessment of chest pain. We recorded baseline information, testing, and outcomes related to ED, observation unit, and inpatient stay. Primary outcomes included gender differences in cardiac catheterization and stenting rates among patients without an MI or positive stress test. Over the 5.5 year study period, 2242 ED patients with chest pain participated in the study (45% male). Men and women had similar rates of cardiac stress testing (16.7% vs. 15.2%, P = 0.317) as well as similar rates of positive cardiac stress testing (2.9% vs. 1.9%, P = 0.116). Men were more likely to undergo cardiac catheterization (10.4% vs. 4.9%, P < 0.001). Men who had neither MI nor positive stress test were more likely than women to undergo cardiac catheterization: 5.8% versus 3.3%, P = 0.010. Similarly, men in this group were more likely to experience stent placement: 2.1% versus 0.7%, P = 0.003. Similar to previous studies, we noted disparities in cardiac testing by gender. Men were more likely to go to cardiac catheterization without an MI or a positive stress test. This disparity in a more aggressive strategy of cardiac catheterization in men may result in higher stenting rates in this group.

The Effect of Implementation of the American Heart Association Mission Lifeline PreAct Algorithm for Prehospital Cardiac Catheterization Laboratory Activation on the Rate of "False Positive" Activations.

Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of "false positive" prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation. This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B. A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B. The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.

ICD Codes for Stress Cardiomyopathy in Administrative Databases Have High Positive Predictive Values

Introduction Stress Cardiomyopathy (SCM) gained an International Classification of Disease code at the 9th- Clinical Modulation (ICD- 9 CM) in 2006. Since then, more than a dozen studies have used these ICD codes for SCM, but no prior study has assessed the reliability of these codes, suggesting that prior reports could have under or overestimated the incidence of this emerging heart failure syndrome. Objective To determine the positive predictive value (PPV) of the ICD 9/10 code to detect a clinical diagnosis of SCM. Methods We conducted a retrospective cohort study of all stress cardiomyopathy cases seen at a large tertiary medical center from 2010-2016. We used ICD-9/10 to identify all adult patients hospitalized with incident SCM. We then used chart review to confirm documentation of SCM, which was confirmed by a cardiologist. We recorded the use of echocardiograms and cardiac angiograms; finally, we determined if patients had a true “incident” clinical manifestation of SCM based on chart review. This determination included documentation of clinical judgement by the clinician, electrocardiogram, biochemical markers, echocardiogram, and cardiac angiographic findings of SCM. We trended the incidence over time using Cochrane Armitage trend test and calculated PPV for the diagnosis of SCM. Results We identified a total of 592 patients hospitalized with SCM ICD-9/10 codes; 242 (41%) consisting of primary SCM codes. Upon chart review, twelve patients (2.2%) had an ICD diagnosis of SCM without any clinical documentation in the chart, which resulted in an overall PPV of 98.0%; 100% PPV for primary, whereas 96.6% for secondary SCM as all the above mentioned 12 patients were coded as secondary SCM. Among primary ICD codes for SCM, 98% had active disease, while 87% of secondary codes had active manifestations of SCM. Primary SCM had higher rates of cardiac catheterization (88% versus 53%; p Conclusions We found that ICD codes for SCM have a high PPV of 98%, which was higher when sample was limited to principle diagnosis of SCM thus, proving good reliability of these ICD codes in identifying SCM. Although our study was not set up to determine sensitivity or specificity of these codes, the high PPV increases our confidence in prior studies of SCM and suggests that future studies using these codes in administrative databases will likely produce valid results.

Abstract 292: Depression is Associated With Decrease in Cardiac Catheterization Rate and Delay in Cardiac Catheterization in Patient With Non-ST-Segment Elevation Myocardial Infarction: Insight From National Inpatient Sample Database

Background: Depression poses a major health challenge to patients with cardiovascular disease. But little is known about its impact on Non-ST-elevation myocardial infarction (NSTEMI). Methods: Using the data from the 2016 National Inpatient Sample database, we identified hospitalization with a principal diagnosis of NSTEMI with or without medical history of depression. Prevalence and baseline characteristic of NSTEMI patient with or without depression was delineated. Mortality, catheterization rate, length of stay, time to catheterization were compared using multivariate linear regression with adjustment for age, sex, race, region, hospital size, Charlson Comorbidity Index, tobacco, heart failure, diabetes, and stable coronary heart disease. Results: Depression was found in 42,914 (9.11%) of total NSTEMI admission of 470,933. A higher percentage of female and a higher prevalence of hypertension, hyperlipidemia, diabetes, and smoking (table 1) was observed in the depression group. No significant association between depression and in-hospital mortality in NSTEMI patient can be found after adjustment for confounders (odds ratio 0.88, p=0.08). However, having depression was associated with lower catheterization rate (odds ratio 0.91, p&lt;0.001), prolonged time to catheterization (1.4 vs 1.2 days, p=0.029) as well as prolonged length of hospital stay (4.9 vs 4.0 days, p&lt;0.001) in admissions because of NSTEMI. Conclusion: Depression is associated with decreased catheterization rate, increased length of stay and delayed catheterization in NSTEMI patient. Further investigation of the impact of depression on NSTEMI patient is warranted.

Sex Differences in Acute Myocardial Infarction Hospital Management and Outcomes

Acute myocardial infarction (AMI) sex disparities in management and outcomes have long been attributed to multiple factors, although questions regarding their relevance have not been fully addressed. The aim of this study was to identify current factors associated with sex-related AMI management and outcomes disparities in hospitals with comparable quality care standards. This is a cross-sectional study of 299 women and 540 men with AMI discharged in 2013 from 3 southern California hospitals with tertiary cardiac care. Outcomes (adjusted by demographic/clinical variables using multiple logistic regression) included mortality (in-hospital, 30 days), 30-day readmissions, invasive/revascularization procedures, and quality medication performance measures (aspirin, statins/antilipids, β-blockers, angiotensin-converting enzyme inhibitors, <90-minute door-balloon time). Performance was similar to the top 10% National Inpatient Quality AMI Measures. Women had similar mortality, 30-day readmission rates, and performance on medication quality measures compared with men; readmissions were higher in patients with County Services/Medicaid or no medical insurance regardless of sex. Women had similar cardiac catheterization and ST-segment elevation myocardial infarction percutaneous coronary intervention rates but significantly less percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (39.1% vs 52.1%, P = .008) and coronary artery bypass graft (6.7% vs 14.1%, P < .001) than men. Women with AMI had similar early mortality, 30-day readmissions and quality performance measures compared with men across hospitals with current quality care standards. Type of medical insurance influenced readmission rates for both sexes. Sex disparities in coronary revascularization procedures were likely determined by differences in AMI type and coronary disease vascular expression.