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Methods: Using the 2004–2013 National Inpatient Sample, the largest publicly available inpatient care database representing more than 95% of the United States population, we extracted data using the ICD 9 code 410.7 (NSTEMI) as the primary diagnosis and the ICD 9 code 585 (CKD) as the secondary diagnosis. We excluded patients with missing information on age, sex, and mortality for a final sample size of 3,784,774. We used multilevel logistic and linear regression models with random effect to adjust for confounding. Results: Among 3,784,774 admissions for NSTEMI, 31% (1,174,006) underwent PCI. Compared to NSTEMI patients undergoing PCI with no kidney dysfunction, NSTEMI patients undergoing PCI with severe kidney dysfunction (stage 5) had a significantly longer length of stay (7.5 days vs 3.5 days, p<.0001), higher cost of hospitalization ($33,620 vs $21,477, p<.0001), greater likelihood to be discharged to a skilled nursing facility (18% vs 5%, p<.0001), greater likelihood to be on Medicare (86% vs 52%, p<.0001), and greater likelihood to be from the lowest income bracket, $0–25,000 (33% vs 27%, p<.0001). NSTEMI patients with any degree of CKD who were on Medicare had a 14% greater mortality and were 52% less likely to undergo PCI compared to NSTEMI who were self-pay (p<.0001). Women with NSTEMI with any of CKD were 25% less likely to undergo PCI compared to men with NSTEMI and any degree of CKD. Conclusion: Among NSTEMI patients undergoing PCI, increasing severity of chronic kidney disease was associated with significantly longer length of stay, higher cost of hospitalization, and a greater likelihood to be discharged to a skilled nursing facility. This subset of patients was also more likely to be of a lower income bracket and to be on Medicare. This knowledge may fuel further studies to identify tools to lessen the socioeconomic differences among NSTEMI patients with varying stages of CKD and address the disparities in utilization of advanced technology in this specific subset of patients.

european heart journal

246Effect of Ivabradine on Mortality in Patients with heart failure and a reduced left ventricular ejection fraction not receiving a beta-blocker: an analysis from SHIFT