Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012])

Panaich, Sidakpal; Arora, Shilpkumar; Patel, Nilay; Schreiber, Theodore; Patel, Nileshkumar; Pandya, Bhavi; Gupta, Vishal; Grines, Cindy L.; Deshmukh, Abhishek; Badheka, Apurva

doi:10.1016/j.amjcard.2016.06.057

Cited by 8 publications

(8 citation statements)

References 14 publications

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“… 2 The challenge of dealing with an increasing number of elderly patients with MI goes beyond a mere statistical increase. Although cardiovascular (CV) death is slowly declining in the general population, it remains unchanged in elderly MI patients because they 2 , 3 , 32 are at higher risk of both ischemic and bleeding complications. 2 , 4.…”

Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

“… 31 Third, the occurrence of procedural complications, especially those impacting the prognosis such as periprocedural MI and Contrast Induced-Acute Kidney Injury (CI-AKI), is directly proportional to both age and number of treated vessels. 32. , 33.…”

Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

“…Fourth, periprocedural complications are associated with a worse prognostic impact in elderly patients. 32. , 33.…”

Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

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Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Biscaglia

Guiducci

Santarelli

et al. 2020

American Heart Journal

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Background Myocardial infarction (MI) in elderly patients is associated with unfavorable prognosis, and it is becoming an increasingly prevalent condition. The prognosis of elderly patients is equally impaired in ST-segment elevation (STE) or non-STE (NSTE), and it is markedly worsened by the common presence of multivessel disease (MVD). Given the limited evidence available for elderly patients, it has not yet been established whether, as for younger patients, a complete revascularization strategy in MI patients with MVD should be advocated. We present the design of a dedicated study that will address this research gap. Methods and design The FIRE trial is a prospective, randomized, international, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients aged 75 years and older, with MI (either STE or NSTE), MVD at coronary artery angiography, and a clear culprit lesion will be randomized to culprit-only treatment or to physiology-guided complete revascularization. The primary end point will be the patient-oriented composite end point of all-cause death, any MI, any stroke, and any revascularization at 1 year. The key secondary end point will be the composite of cardiovascular death and MI. Quality of life and physical performance will be evaluated as well. All components of the primary and key secondary outcome will be tested also at 3 and 5 years. The sample size for the study is 1,400 patients. Implications The FIRE trial will provide evidence on whether a specific revascularization strategy should be applied to elderly patients presenting MI and MVD to improve their clinical outcomes.

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Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

Section: Myocardial Infarction In Elderly Adultsmentioning

confidence: 99%

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Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Biscaglia

Guiducci

Santarelli

et al. 2020

American Heart Journal

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“…We also included a broad list of both procedural complications as well as readmission etiologies than previously reported for this procedure. Similar databases from HCUP have been used extensively for studying procedural outcomes .…”

Section: Limitationsmentioning

confidence: 99%

Procedural trends, outcomes, and readmission rates pre‐and post‐FDA approval for MitraClip from the National Readmission Database (2013–14)

Panaich

Arora

Badheka

et al. 2017

Cathet Cardio Intervent

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“…Despite the improvements in early coronary angiography and prompt percutaneous coronary intervention (PCI), STEMI continues to be associated with considerable mortality and morbidity. In addition, STEMI is associated with high resource utilization with estimated costs of hospitalization of United States Dollars 21,000-26,000 [5].…”

Section: Introductionmentioning

confidence: 99%

Influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction in the United States

et al. 2020

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Background There are limited contemporary data on the influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction (STEMI). Objective To assess the influence of insurance status on STEMI outcomes. Methods Adult (>18 years) STEMI admissions were identified using the National Inpatient Sample database (2000–2017). Expected primary payer was classified into Medicare, Medicaid, private, uninsured and others. Outcomes of interest included in-hospital mortality, use of coronary angiography and percutaneous coronary intervention (PCI), hospitalization costs, hospital length of stay and discharge disposition. Results Of the 4,310,703 STEMI admissions, Medicare, Medicaid, private, uninsured and other insurances were noted in 49.0%, 6.3%, 34.4%, 7.2% and 3.1%, respectively. Compared to the others, the Medicare cohort was older (75 vs. 53–57 years), more often female (46% vs. 20–36%), of white race, and with higher comorbidity (all p<0.001). The Medicare and Medicaid population had higher rates of cardiogenic shock and cardiac arrest. The Medicare cohort had higher in-hospital mortality (14.2%) compared to the other groups (4.1–6.7%), p<0.001. In a multivariable analysis (Medicare referent), in-hospital mortality was higher in uninsured (adjusted odds ratio (aOR) 1.14 [95% confidence interval {CI} 1.11–1.16]), and lower in Medicaid (aOR 0.96 [95% CI 0.94–0.99]; p = 0.002), privately insured (aOR 0.73 [95% CI 0.72–0.75]) and other insurance (aOR 0.91 [95% CI 0.88–0.94]); all p<0.001. Coronary angiography (60% vs. 77–82%) and PCI (45% vs. 63–70%) were used less frequently in the Medicare population compared to others. The Medicare and Medicaid populations had longer lengths of hospital stay, and the Medicare population had the lowest hospitalization costs and fewer discharges to home. Conclusions Compared to other types of primary payers, STEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher in-hospital mortality.

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Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012])

Cited by 8 publications

References 14 publications

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Physiology-guided revascularization versus optimal medical therapy of nonculprit lesions in elderly patients with myocardial infarction: Rationale and design of the FIRE trial

Procedural trends, outcomes, and readmission rates pre‐and post‐FDA approval for MitraClip from the National Readmission Database (2013–14)

Influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction in the United States

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