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.
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.
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Shannon M Dunlay; Abhiram Prasad; Malcolm R Bell; Allan S Jaffe; Bernard J Gersh; Charanjit S Rihal; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-02-14 Impact factor: 8.790
Authors: Andrea M Steely; Peter W Callas; Daniel Neal; Salvatore T Scali; Philip P Goodney; Andres Schanzer; Jack L Cronenwett; Daniel J Bertges Journal: Ann Vasc Surg Date: 2016-11-29 Impact factor: 1.466
Authors: Eun Ji Kim; Victoria A Parker; Jane M Liebschutz; Joseph Conigliaro; Jean DeGeorge; Amresh D Hanchate Journal: J Am Heart Assoc Date: 2019-11-29 Impact factor: 5.501
Authors: Paula M Janssen; Katrine van Overhagen; Jan Vinklárek; Bob Roozenbeek; H Bart van der Worp; Charles B Majoie; Michal Bar; David Černík; Roman Herzig; Lubomir Jurák; Svatopluk Ostrý; Robert Mikulik; Hester F Lingsma; Diederik W J Dippel Journal: Circ Cardiovasc Qual Outcomes Date: 2022-01-31
Authors: M Hall; K Laut; T B Dondo; O A Alabas; R A Brogan; N Gutacker; R Cookson; P Norman; A Timmis; M de Belder; P F Ludman; C P Gale Journal: Heart Date: 2016-01-05 Impact factor: 5.994
Authors: Eun Ji Kim; Nancy R Kressin; Michael K Paasche-Orlow; Lenny Lopez; Jennifer E Rosen; Mengyun Lin; Amresh D Hanchate Journal: BMC Health Serv Res Date: 2018-05-16 Impact factor: 2.655