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.