Abstract 22: STEMI Trends in the United States 2002-2010: Increasing Use of PCI and Declining Mortality

Abstract

Objective: We sought to quantify changes in STEMI mortality and percutaneous coronary intervention (PCI) use in the United States (US) from 2002 to 2010. Methods: We used the Nationwide Inpatient Sample (NIS), an all-payer discharge database, to create estimates of STEMI, STEMI in-hospital mortality, and PCI use. The NIS includes hospitals selected to approximate 20% of all non-federal US hospitals and includes weights to create national estimates. STEMI cases were identified based on primary diagnostic code. High volume STEMI-PCI centers were defined as >36 cases/year, according to PCI guidelines. Temporal trends were evaluated with logistic regression, adjusted for patient and hospital characteristics. Discharges to other acute care facilities were excluded for outcomes analyses. Results: We identified 1,944,112 STEMI discharges in the US; mean age was 64 years, 34% were women, and 46% were Medicare insured. The absolute number of STEMI discharges declined from 299,441 in 2002 to 167,929 in 2010 (Figure). The number of hospitals performing zero STEMI-related PCIs decreased from 75% (3633/4840) to 68% (3514/5134) between 2002 and 2010. The number of high volume centers increased from 20% (949/4840) to 24% (1235/4840) over the same period. Overall, 64% (1,145,196/1,783,825) of discharges received PCI and 8.5% (151,528/1,783,825) died during hospitalization. PCI use increased and mortality decreased over time (Figure). The adjusted odds of PCI use for STEMI discharges increased over three fold during the study period (OR 3.51 in 2010 versus 2002, 95% CI 3.21 to 3.83). The adjusted odds of death decreased by one fifth (OR 0.81 in 2010 versus 2002, 95% CI 0.75 to 0.87). Inclusion of PCI in the model attenuated the effect of year on death (OR 1.06 in 2010 versus 2002, 95% CI 0.98 to 1.14). Conclusions: In this study we demonstrate favorable trends in STEMI outcomes. Between 2002 and 2010, the absolute number of STEMIs in the US decreased, while more hospitals provided PCI for STEMI. Over time, more discharges were treated with PCI and fewer died during hospitalization.