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We evaluated whether insurance status is associated with delays in PCI reperfusion for patients with ST elevation myocardial infarction (STEMI).
We analyzed data from the CathPCI Registry®. Median DTB time, patient demographics, clinical history and hospital characteristics were analyzed and stratified by transfer status. Adjusted differences in DTB time by insurance status were calculated by multivariate quantile regression.
Between July 1, 2009 and June 30, 2011, 69,449 adult patients under the age of 65 underwent primary PCI for STEMI. Unadjusted median DTB times were longer and more variable among transferred patients (see Table). Transferred patients with private insurance had lower unadjusted median DTB times (−3 min; 95% CI = (−4.7,-1.3); p<0.001) while those with Medicaid had higher median DTB times (5 min; 95% CI = (2.0–8.0); P=0.001) when compared to patients without insurance. After multivariate adjustment, only the difference between private and uninsured patients remained statistically significant (−1.8 min; 95% CI = (−3.4,-0.2); P=0.03). Similar results were seen for the comparison of median DTB between uninsured and Medicaid patients among those not transferred (unadjusted: 3.0 min; 95% CI = 1.9–4.1;p<0.001) and adjusted: 1.5 min; 95% CI = (0.4,2.6); P=0.008).
In this large, multicenter cohort of STEMI patients undergoing PCI, there was a small but statistically significant delay in DTB time for Medicaid and uninsured patients.
DTB Time (minutes) across insurance payer status
|Insurance Payer Status||Transferred Patients N=18,151||Non-transferred Patients N=51,298|
|Median (Q1-Q3)||Median (Q1-Q3)|
|Uninsured||114 (90–149)||60 (47–74)|
|Private||111 (89–144)||60 (46–75)|
|Medicaid||119 (93–155)||63 (47–77)|
|Other||116 (93–155)||61 (47–75)|
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: STEMI Topics
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1171-211
- 2013 American College of Cardiology Foundation