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Percutaneous versus Surgical Revascularization for Acute Myocardial Infarction
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  • Tariq Enezate,
  • Cliff Chen,
  • Kristina Gifft,
  • Jad Omran,
  • Mohammad Eniezat,
  • Michael Readon
Tariq Enezate
University of California Los Angeles
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Cliff Chen
University of Missouri Health System
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Kristina Gifft
University of Missouri Columbia Health Care
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Jad Omran
University of California San Diego
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Mohammad Eniezat
Jordan University of Science and Technology
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Michael Readon
Houston Methodist Hospital
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Peer review status:UNDER REVIEW

31 Jul 2020Submitted to Journal of Cardiac Surgery
01 Aug 2020Assigned to Editor
01 Aug 2020Submission Checks Completed
01 Aug 2020Reviewer(s) Assigned

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.