Open AccessRegional Variation Across the United States in Management and Outcomes of ST ‐Elevation Myocardial Infarction: Analysis of the 2003 to 2010 Nationwide Inpatient Sample Database
Author(s) -
Kolte Dhaval,
Khera Sahil,
Aronow Wilbert S.,
Mujib Marjan,
Palaniswamy Chandrasekar,
Ahmed Ali,
Frishman William H.,
Fonarow Gregg C.
Publication year - 2014
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22250
Subject(s) - medicine , myocardial infarction , elevation (ballistics) , sample (material) , database , variation (astronomy) , emergency medicine , chemistry , physics , geometry , mathematics , chromatography , computer science , astrophysics
Background Regional differences in the treatment and outcomes of patients with ST ‐elevation myocardial infarction ( STEMI ) within the United States remain poorly understood. Hypothesis Treatment choice and outcomes in patients with STEMI differ between regions within the United States. Methods We used the 2003 to 2010 Nationwide Inpatient Sample databases to identify all patients age ≥40 years hospitalized with STEMI . Patients were divided into 4 groups according to region: Northeast, Midwest, South, and West. Multivariable logistic regression was used to identify differences in treatment choice and outcomes (in‐hospital mortality, acute stroke, and cardiogenic shock) among the 4 regions. Results Of 1 990 486 patients age ≥40 years with STEMI , 350 073 (17.6%) were hospitalized in the Northeast, 483 323 (24.3%) in the Midwest, 784 869 (39.4%) in the South, and 372 222 (18.7%) in the West. Compared with the Northeast, patients in the Midwest, South, and West were less likely to receive medical therapy alone and more likely to receive percutaneous coronary intervention and coronary artery bypass grafting. Risk‐adjusted in‐hospital mortality was higher in the Midwest (odds ratio [ OR ]: 1.07, 95% confidence interval [ CI ]: 1.05‐1.09, P <0.001), South ( OR : 1.03, 95% CI : 1.01‐1.05, P = 0.001), and West ( OR : 1.06, 95% CI : 1.04‐1.08, P <0.001), as compared with the Northeast. When adjusted further for regional variation in treatment selection, risk‐adjusted in‐hospital mortality was even higher in the Midwest, West, and South. Conclusions Despite higher reperfusion and revascularization rates, STEMI patients in the Midwest, West, and South have paradoxically higher risk‐adjusted in‐hospital mortality as compared with patients in the Northeast.