Increased mortality for percutaneous coronary intervention at safety-net hospitals
Risk-adjusted in-hospital mortality is significantly increased at safety-net hospitals in patients undergoing PCI.
(HealthDay News) — For patients undergoing percutaneous coronary intervention (PCI), risk-adjusted in-hospital mortality is significantly increased at safety-net hospitals (SNHs), although the absolute difference is small, according to a study published in JACC: Cardiovascular Interventions.
Tushar Acharya, MD, from the University of California in San Francisco, and colleagues analyzed 3,746,961 patients who underwent PCI at 282 SNHs and 1,134 non-SNHs. The authors examined the correlation between SNH status and risk-adjusted outcomes.
The researchers found that patients treated at SNHs were significantly more likely to be younger, nonwhite, smokers, to be admitted through the emergency department, and to have an ST-segment elevation myocardial infarction than those treated at non-SNHs (all P<.001). Risk-adjusted in-hospital mortality was higher for patients undergoing PCI at SNHs (odds ratio, 1.23; 95% confidence interval, 1.17 to 1.32; P<.001), although the difference between the groups was small (0.4%). Similar rates of risk-adjusted bleeding (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.12; P=.062) and acute kidney injury (odds ratio, 1.01; 95% confidence interval, 0.96 to 1.07; P=.51) were seen.
"Despite treating a higher proportion of uninsured patients with more acute presentations, risk-adjusted PCI-related in-hospital mortality of SNHs is only marginally higher (4 additional deaths per 1,000 PCI cases) than non-SNHs, whereas risk-adjusted bleeding and acute kidney injury rates are comparable," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
- Acharya T, Salisbury AC, Spertus JA, et al. In-hospital mortality outcomes of percutaneous coronary intervention in America's safety-net: Insights from the NCDR Cath-PCI Registry. JACC Cardiovasc Interv. 2017;10(15).