THE IN-HOSPITAL IMPACT OF COMORBID CONDITIONS ON PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI). A RETROSPECTIVE STUDY INVOLVING THE NATIONAL INPATIENT SAMPLE (NIS 2016-2021)

Therapeutic Area

ASCVD/CVD Risk Assessment

Background

ST-segment elevation myocardial infarction (STEMI) requires urgent revascularization, typically achieved through percutaneous coronary intervention (PCI). While advancements in PCI techniques and pharmacotherapy have improved outcomes, the presence of comorbidities continues to exert a significant impact on patients undergoing PCI for STEMI.

Methods

This study utilized the National Inpatient Sample (NIS) to identify patients who underwent PCI for STEMI between 2016 and 2021. Key comorbidities, including obesity, hypertensive heart disease, diabetes, hyperlipidemia, congestive heart failure (CHF), chronic kidney disease (CKD), peripheral arterial disease (PAD), tobacco use, previous myocardial infarction, and prior PCI, were examined. Logistic and linear regression analyses were performed to assess the impact of these comorbidities on in-hospital mortality, length of hospitalization, hospital costs, and post-procedural complications.

Results

A weighted national estimate of 807,780 patients underwent PCI for STEMI. Significantly higher odds of in-hospital mortality were observed in patients with CHF (aOR: 2.19, 95% CI: 2.08-2.30, p<0.0001), PAD (aOR: 1.67, 95% CI: 1.50-1.87, p<0.0001), CKD (aOR: 1.47, 95% CI: 1.38-1.56, p<0.0001), and diabetes (aOR: 1.40, 95% CI: 1.33-1.47, p<0.0001). CHF was associated with the longest hospital stay (+2.48 days, 95% CI: 2.41-2.55, p<0.0001) and highest hospital costs (+$65,400, 95% CI: $62,444-$68,357, p<0.0001). CHF also carried the highest odds of post-procedure cardiac arrest (aOR: 3.50, 95% CI: 1.408.74, p<0.007) and cardiogenic shock (aOR: 3.60, 95% CI: 2.77-4.68, p<0.0001). CKD was linked to the highest odds of post-procedure kidney failure (aOR: 2.37, 95% CI: 1.26-4.46, p<0.007).

Conclusions

CHF, PAD, CKD, and diabetes significantly increased in-hospital mortality risk after PCI for STEMI. CHF was also associated with the longest hospital stay, highest costs, and the greatest risk of cardiac arrest and cardiogenic shock. CKD was most strongly linked to post-procedure kidney failure. These findings highlight the need for targeted management strategies to optimize outcomes in high-risk patients undergoing PCI for STEMI.