Decreasing In-hospital Mortality of Patients Undergoing PCI
Background. Advances in interventional techniques have been dramatic in the last 10 years. The goal of this study was to evaluate the age-adjusted in-hospital mortality rate in patients undergoing percutaneous coronary intervention (PCI) using a large database.
Methods. The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate for PCI from 1988 to 2004 in patients over the age of 40 retrospectively. Specific ICD-9-CM codes for PCI were used for this study. Demographic data were also analyzed and adjusted for age.
Results. The mean age for these patients was 71.56 ± 10.59 years (53.55% male). From 1988 to 1995, the age-adjusted mortality rate was stable. However, after 1995 the age-adjusted mortality rate showed persistent decline to the lowest level in 2004. (In 1988, age-adjusted mortality rate was 75.43 per 100,000 [95% CI = −7.88–158.76], in 1995, 66.83 per 100,000 [95% CI = 24.62–109.050] and in 2004, 38.38 per 100,000 [95% CI 19.53–57.22]; p < 0.01). Total death also declined from 1.8% to 1.2%. This trend was similar across gender and ethnicities except for Asians. Furthermore, minorities and women had persistently higher mortality in comparison to males and Caucasians.
Conclusion. The age-adjusted in-hospital mortality rate from PCI was steady until 1995 and declined to its lowest level in 2004. Despite this decline, racial and gender disparity in regard to mortality persisted over the study years.
Percutaneous coronary intervention (PCI) is the most common interventional procedure for coronary artery revascularization. The number of PCI procedures has increased in recent years due to increased awareness and improved outcomes compared to fibrinolytic therapy for coronary artery disease (CAD). Meta-analyses of randomized clinical trials have reported that primary PCI is more cost-effective compared to fibrinolysis and reduces the incidence of death, reinfarction, and stroke. Furthermore, in stable patients and in patients with multivessel disease, PCI has become the preferred procedure in the United States, with declining mortality in patients undergoing multivessel PCI. Despite increasing utilization of PCI in the United States, the mortality trends from PCI based on race and gender have not been studied in recent years. We sought to identify the temporal trends of in-hospital PCI-related mortality in a large patient cohort from 1998 to 2004 in the United States based on gender and ethnicity.
Abstract and Introduction
Abstract
Background. Advances in interventional techniques have been dramatic in the last 10 years. The goal of this study was to evaluate the age-adjusted in-hospital mortality rate in patients undergoing percutaneous coronary intervention (PCI) using a large database.
Methods. The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate for PCI from 1988 to 2004 in patients over the age of 40 retrospectively. Specific ICD-9-CM codes for PCI were used for this study. Demographic data were also analyzed and adjusted for age.
Results. The mean age for these patients was 71.56 ± 10.59 years (53.55% male). From 1988 to 1995, the age-adjusted mortality rate was stable. However, after 1995 the age-adjusted mortality rate showed persistent decline to the lowest level in 2004. (In 1988, age-adjusted mortality rate was 75.43 per 100,000 [95% CI = −7.88–158.76], in 1995, 66.83 per 100,000 [95% CI = 24.62–109.050] and in 2004, 38.38 per 100,000 [95% CI 19.53–57.22]; p < 0.01). Total death also declined from 1.8% to 1.2%. This trend was similar across gender and ethnicities except for Asians. Furthermore, minorities and women had persistently higher mortality in comparison to males and Caucasians.
Conclusion. The age-adjusted in-hospital mortality rate from PCI was steady until 1995 and declined to its lowest level in 2004. Despite this decline, racial and gender disparity in regard to mortality persisted over the study years.
Introduction
Percutaneous coronary intervention (PCI) is the most common interventional procedure for coronary artery revascularization. The number of PCI procedures has increased in recent years due to increased awareness and improved outcomes compared to fibrinolytic therapy for coronary artery disease (CAD). Meta-analyses of randomized clinical trials have reported that primary PCI is more cost-effective compared to fibrinolysis and reduces the incidence of death, reinfarction, and stroke. Furthermore, in stable patients and in patients with multivessel disease, PCI has become the preferred procedure in the United States, with declining mortality in patients undergoing multivessel PCI. Despite increasing utilization of PCI in the United States, the mortality trends from PCI based on race and gender have not been studied in recent years. We sought to identify the temporal trends of in-hospital PCI-related mortality in a large patient cohort from 1998 to 2004 in the United States based on gender and ethnicity.
SHARE
