Abstract
Acute myocardial infarction (AMI) is a common medical condition that
requires appropriate revascularization in a timely manner. Percutaneous
revascularization (PR) was the first line treatment option when
feasible. Limited data is available comparing PR to surgical
revascularization (SR) in the AMI setting. Study population was
extracted from the 2016 Nationwide Readmissions Data using International
Classification of Diseases, tenth edition codes for AMI, PR, SR, and
procedural complications. Endpoints included in-hospital all-cause
mortality, length of index hospital stay (LOS), stroke, acute kidney
injury, bleeding, blood transfusion, acute respiratory failure, and
total hospital charges. The study identified 45,539 discharges with a
principal admission diagnosis of AMI who had either PR or SR as a
principal procedure. Single vessel revascularization was performed in
67.8% (93.1% had PR versus 6.9% had SR, p<0.01).
Multivessel revascularization was performed in 32.2% (64.8% had PR
versus 35.2% had SR, p<0.01). In comparison to SR, PR was
associated with higher in-hospital all-cause mortality
(P<0.01), shorter LOS (p<0.01), and lower incidence
of post-procedural stroke (p<0.01), acute kidney injury
(p<0.01), bleeding (p<0.01), need for blood
transfusion (p<0.01), acute respiratory failure
(p<0.01), and total hospital charges (p<0.01). In a
subgroup analysis, SR mortality benefit persisted in patients who had
multivessel revascularization, but not in single vessel
revascularization. In patients presented with AMI, PR was associated
with higher in-hospital all-cause mortality but lower morbidity, shorter
LOS, and lower total hospital charges than SR. However, the mortality
benefit of SR was seen in multivessel revascularization only, and not in
single vessel revascularization.