In-hospital Outcomes and Cost Associated With Treatments for Non–ST-elevation Myocardial Infarction

• Published in: Journal of the Society for Cardiovascular Angiography & Interventions 2023-01, Vol.2 (1), p.100532, Article 100532
• Main Authors: Lima, Fabio V., Kennedy, Kevin F., Saad, Marwan, Kolte, Dhaval, Foley, Katelyn, Abbott, J. Dawn, Aronow, Herbert D.
• Format: Article
• Language: English
• Subjects: coronary artery bypass graft surgery; non–ST-elevation myocardial infarction; percutaneous coronary intervention; variation
• ISSN: 2772-9303; 2772-9303
• DOI: 10.1016/j.jscai.2022.100532

Although variation in the management of patients with non–ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing variation in outcomes following specific management strategies. Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included variation in length of stay (LOS), cost, and use of each treatment modality. Variation was characterized by the median odds ratio. Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality. In a large national analysis of hospitalizations for NSTEMI, significant variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors. [Display omitted] •Most non–ST-elevation myocardial infarction patients underwent invasive treatment.•One randomly selected hospital was compared to another.•The composite endpoint was 25% more likely after percutaneous coronary intervention.•The composite endpoint was 45% more likely after coronary artery bypass surgery.•Hospital-level variation existed for length of stay and cost for each treatment.