Influence of Hospital Size on Outcomes in St-Segment Myocardial Infarction Among Patients Hospitalized for Non-Cardiac Indications

Document Type

Conference Proceeding

Publication Date

4-6-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background

Patients who experience ST-segment elevation myocardial infarction (STEMI) while hospitalized for non-cardiac reasons (inpatient STEMI; IPS) have higher mortality rates than patients who have onset of STEMI while outside the hospital (outpatient STEMI; OPS). However, the influence of hospital size on outcomes in inpatient STEMI has not been studied.

Methods

We performed a search within the New York Statewide Planning and Research Cooperative System (SPARCS) database to identify all occurrences of STEMI cases from 2011 and 2018. SPARCS is a comprehensive all-payer data reporting system encompassing all non-federal hospitals in New York. Patients were stratified into IPS vs OPS depending on whether STEMI was present on admission. Hospitals were classified into tertiles based on discharges, with the median number of annual discharges being 2871, 13448 and 27248 in groups 1, 2 and 3, respectively.

Results

A total of 64,960 cases of STEMIs were identified across 231 hospitals with 2,880 (4.4%) classified as IPS. Overall, IPS patients tended to be older (73.5 ± 13.3 years vs 64.6 ± 14.2 years; p < 0.05), more likely to be female (49.3% vs 33.1%; p < 0.05), more likely to be African American (11.9% vs 8.7%; p < 0.05), to have more comorbidities, less likely to undergo percutaneous coronary intervention (PCI; 13.1% vs 69.4%; p < 0.05) and much more likely to die within one year (59.6% vs 16.4%; p < 0.05) compared to OPS patients. IPS patients treated at smaller hospitals were older, more often female, more likely to have chronic obstructive pulmonary disease (COPD) and less likely to have had a stroke than IPS treated at groups 2 and 3 hospitals. Patients at group 1 hospitals were less likely to receive PCI (2.0% vs 12.0% vs 19.9%; p < 0.05) and more likely to die at one year (63.4% vs 61.7% vs 55.9%; p < 0.05) than patients at group 2 and or group 3 hospitals, respectively. Interestingly, IPS patients who received PCI had similar mortality independent of hospital size (38.5% vs 28.6% vs 28.6%; p = 0.75).

Conclusion

IPS patients treated in smaller-sized hospitals were less likely to undergo PCI and had a higher one year mortality than IPS patients treated at larger hospitals.

Volume

83

Issue

13_Supplement

First Page

1196

Comments

2024 American College of Cardiology Scientific Sessions, April 6-8, 2025, Atlanta, GA.

DOI

10.1016/S0735-1097(24)03186-3

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