Use of Intravascular Imaging in Patients With ST-Segment Elevation Acute Myocardial Infarction |
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| Affiliation: | 1. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston;2. Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar;3. Division of Cardiothoracic Surgery, Baylor School of Medicine, Houston, Tex;4. Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn;5. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston;6. Department of Cardiovascular Medicine, University of Kentucky, Lexington;7. Division of Cardiology, Baylor School of Medicine, Houston, Tex;1. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston;2. Division of Rheumatology and Clinial Immunology, University of Alabama at Birmingham, Birmingham;3. Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston;4. Division of Cardiovascular Medicine, University of Missouri-Kansas City;5. Department of Cardiovascular Medicine, University of Kentucky, Lexington;6. Department of Internal Medicine, Cairo University, Cairo, Egypt;7. Division of Cardiology, Baylor School of Medicine, Houston, Texas;1. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas;2. Department of Internal Medicine, University of Florida, Gainesville, Florida;3. Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas;4. Department of Internal Medicine, Houston Medical Center, Warner Robins, Georgia;5. Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;6. Department of Cardiovascular Medicine, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota;7. Department of Internal Medicine, Rochester General Hospital, Rochester, New York;8. Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky;9. Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt;10. Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Texas |
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| Abstract: | ![]()
BackgroundThe use and impact of intravascular imaging in ST-elevation myocardial infarction (STEMI) patients has received limited study.MethodsWe queried the National Inpatient Sample database (NIS) between January 2016 and December 2017 to identify hospitalizations of STEMI patients who underwent percutaneous coronary intervention (PCI). We used a 1:2 propensity-score (PS) matched analysis to compare in-hospital outcomes in patients with vs. without use of intravascular imaging. We conducted a multivariable regression analysis to identify variables independently associated with in-hospital mortality.ResultsWe identified 252,970 weighted discharges of PCI in STEMI patients, 5.5% of which included intravascular imaging. Patients in whom intravascular imaging was used were more likely to have acute stent thrombosis (4.7% vs. 1.4%, p < 0.001) and present with anterior STEMI (48.1% vs. 39.1%, p < 0.001). After PS matching (intravascular imaging n = 14,015, no intravascular imaging n = 28,025), the use of intravascular imaging was associated with lower in-hospital mortality (3.6% vs. 4.8%, p = 0.010). The risk of in-hospital complications and discharge to a facility (nursing facility or short-term acute hospital) was similar between both groups before and after PS matching. The use of intravascular imaging was associated with a higher index hospitalization cost [$25,218 vs. $20,515, p < 0.001]. On multivariable analysis, intravascular imaging was independently associated with lower in-hospital mortality [OR 0.735 (95% CI 0.662–0.816), p < 0.001].ConclusionIntravascular imaging was used in 5.5% of PCIs in STEMI patients and was independently associated with lower in-hospital mortality and higher index hospitalization cost. |
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