Clinical and Economic Burden Following Percutaneous Coronary Intervention for STEMI: A US Real-World Evidence Study.

Abstract

Introduction: ST-segment-elevation myocardial infarction (STEMI) affects approximately 250,000 people in the U.S. annually, causing substantial morbidity and mortality. One-year outcomes following percutaneous coronary intervention (PCI) for STEMI vary across studies.

Aim: To assess clinical and economic outcomes following PCI among patients with STEMI.

Methods: This study analyzed adult patients with STEMI undergoing PCI between 2016 and 2021, using Premier Healthcare Database and additional mortality and claims data. Clinical outcomes, healthcare resource use, and costs following first PCI discharge (index visit) were assessed for at least 1 year, with outcomes at 3-year follow-up assessed among a subset of patients. Multivariable regression (Cox, logistic or generalized linear) was used to identify risk factors for key outcomes.

Results: A total of 180,691 patients underwent PCI for STEMI in 633 US hospitals during the study period. The median age was 62 years, most were male (71%), non-Hispanic White (62.7%), and had Medicare as the primary payor (42.9%). At index visit, 13.8% had ventricular tachycardia, 8.8% had ventricular fibrillation, with a median cost of $17,582, and a mortality rate of 5.5%. Within 1 year, there were 1,966 (1.1%) additional deaths, 17.4% were readmitted, 13.4% developed heart failure (HF), 2.5% were hospitalized primarily for HF (HHF), 3.9% had atrial fibrillation, and 1% experienced recurrent STEMI. The median total study cost by 1 year was $21,010. A Charlson Comorbidity Index (CCI) score of ≥4 (vs <4) at index visit was most strongly associated with higher risk of death at 1 year: hazard ratio: 4.1, (95% CI: 3.66 to 4.49), higher odds of readmissions (OR: 2.6, 95% CI: 2.50 to 2.70), HHF (OR: 4.1 (95% CI: 3.83 to 4.42)), and 74% higher costs (p<0.05). Similar associations were observed at 3-year follow-up (n=59,714).

Conclusion: This study identified risk factors associated with one-year negative clinical outcomes and increased cost following PCI for the treatment of STEMI.