RESULTS
The 2016 NRD database included approximately 17.2 million discharges. There were 328,570 discharges with a principal diagnosis of AMI. Of which, 45,539 (38.7% ST elevation and 61.3% non-ST elevation) had either PR 79.1% or SR 20.9% as a principal procedure, Figure 1. The mean age of the overall cohort was 64.8+ 12.2 years and 29.8% were women. History of CAD, hypertension, hyperlipidemia, diabetes, and smoking were the most common comorbidities, Table 1.
SR group had significantly more comorbidities including congestive heart failure and diabetes. Single vessel revascularization was performed in 67.8% (93.1% PR versus 6.9% SR, p<0.01). Multivessel revascularization was performed in 32.2% (64.8% PR versus 35.2% SR, p<0.01). 16.5% in the SR group had ST elevation AMI and 83.2% had non-ST elevations, while 44.6% of the PR group had ST elevation and 54.9% had non-ST elevation AMI, Table 1.
In comparison to SR, PR was associated with higher in-hospital all-cause mortality (3.7% versus 2.2%, P<0.01), shorter LOS (4.3 versus 11.6 days, p<0.01), and lower incidence of post-procedural stroke (1.0% versus 1.8%, p<0.01), acute kidney injury (14.9% versus 24.8%, p<0.01), bleeding (4.3% versus 47.1%, p<0.01), need for blood transfusion (2.9% versus 18.5%, p<0.01), acute respiratory failure (10.7% versus 19.8%, p<0.01), and total hospital charges (120,590$ versus 229,917$, p<0.01) (Table 2).
There were 6,938 comparable pairs were identified using propensity matching (Table 1), these pairs also comparable in terms of cardiogenic shock (10.0% versus 9.5%, p=0.35) and mechanical complications of AMI (0.2% versus 0.2%, p=055). The results remained consistent after propensity matching (Table 2).
In subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization (in both ST and non-ST elevation AMI), but not in single vessel revascularization. Furthermore, the mortality benefit persisted in patients with and without diabetes, systolic heart failure, cardiogenic shock and mechanical complications of AMI.