Author + information
- Jordan B. Strom,
- James McCabe,
- Stephen Waldo,
- Duane Pinto,
- Kevin Kennedy,
- Dmitriy Feldman and
- Robert Yeh
Background: In 2010, New York State began excluding selected patients with cardiac arrest and coma from publicly reported mortality statistics after percutaneous coronary intervention (PCI). The impact of this policy change has not been evaluated. Thus, we evaluated the effects of the New York cardiac arrest exclusion policy on rates of coronary angiography, revascularization, and mortality among patients with acute myocardial infarction (AMI) complicated by cardiac arrest.
Methods: Using statewide hospitalization files, we identified patients hospitalized for AMI with concomitant cardiac arrest from January 2003 through December 2013 in New York and a series of comparator states. A difference-in-differences approach was used to evaluate the likelihood of coronary angiography, revascularization, and in-hospital mortality before and after selected cardiac arrest cases were excluded from public reporting in New York.
Results: A total of 26,3679 patients with AMI and cardiac arrest (5,619 in New York State) were included. Of these, 17,141 (65%) underwent coronary angiography, 12,183 (46.2%) underwent PCI and 2,832 (10.7%) underwent CABG. Prior to 2010, cardiac arrest patients in New York were less likely to undergo PCI compared with referent states (aRR 0.79, 95% CI 0,73-0.85, p<0.001). This relationship was unchanged after exclusion of selected cardiac arrest cases from public reporting (aRR 0.82, 95% CI 0.76-0.89, interaction p = 0.359). Adjusted risks of in-hospital mortality between New York and comparator states after the policy change were also similar (aRR 0.94, 95% CI 0.87-1.02, p = 0.152 for post- vs. pre-2010 in New York, aRR 0.88, 95% CI 0.84-0.92, p <0.001 for comparator states; interaction p = 0.103).
Conclusions: Exclusion of selected cardiac arrest cases from public reporting was not associated with changes in rates of percutaneous revascularization or in-hospital mortality for these patients in New York. Rates of revascularization in New York for cardiac arrest patients were lower throughout the study.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: PCI and TAVR in Complex Patients
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1239-130
- 2017 American College of Cardiology Foundation