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In-Hospital Mortality Higher for PCI at Safety Net Hospitals

TUESDAY, Aug. 8, 2017 -- For patients undergoing percutaneous coronary intervention (PCI), risk-adjusted in-hospital mortality is significantly increased at safety-net hospitals (SNHs), although the absolute difference is small, according to a study published in the Aug. 14 issue of JACC: Cardiovascular Interventions.

Tushar Acharya, M.D., from the University of California in San Francisco, and colleagues analyzed 3,746,961 patients who underwent PCI at 282 SNHs and 1,134 non-SNHs. The authors examined the correlation between SNH status and risk-adjusted outcomes.

The researchers found that patients treated at SNHs were significantly more likely to be younger, nonwhite, smokers, to be admitted through the emergency department, and to have an ST-segment elevation myocardial infarction than those treated at non-SNHs (all P < 0.001). Risk-adjusted in-hospital mortality was higher for patients undergoing PCI at SNHs (odds ratio, 1.23; 95 percent confidence interval, 1.17 to 1.32; P < 0.001), although the difference between the groups was small (0.4 percent). Similar rates of risk-adjusted bleeding (odds ratio, 1.05; 95 percent confidence interval, 1.00 to 1.12; P = 0.062) and acute kidney injury (odds ratio, 1.01; 95 percent confidence interval, 0.96 to 1.07; P = 0.51) were seen.

"Despite treating a higher proportion of uninsured patients with more acute presentations, risk-adjusted PCI-related in-hospital mortality of SNHs is only marginally higher (four additional deaths per 1,000 PCI cases) than non-SNHs, whereas risk-adjusted bleeding and acute kidney injury rates are comparable," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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Posted: August 2017