In Medicare beneficiaries with anterior STEMI, 1-year adjusted mortality increased by 2.3% (95% CI 0.8-3.7; p<0.01) in the 2016-2017 cohort compared to the 2005 cohort.
Cohort (n=23,911)
Yes
Does primary PCI in the contemporary era (2016-2017) improve mortality and CHF rehospitalization compared to the historical era (2005) in Medicare beneficiaries with anterior STEMI?
Despite broad adoption of timely primary PCI, contemporary Medicare beneficiaries with anterior STEMI continue to experience a persistently high, and potentially increasing, burden of mortality and heart failure compared to a decade prior.
Effect estimate: Adjusted absolute increase 2.3% (95% CI 0.8 to 3.7)
Absolute Event Rate: 10.3% vs 8.9%
p-value: p=<0.01
OBJECTIVES: We sought to compare the temporal trends in the incidence of death and rehospitalisation for congestive heart failure (CHF) following anterior ST-elevation myocardial infarction (STEMI) in a Medicare cohort of beneficiaries treated with primary percutaneous coronary intervention (PCI) in 2005 (n=1479) with those treated in 2016 through quarter (Q) 2 of 2017 (n=22 432). DESIGN: This retrospective analysis examined outcomes using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. PRIMARY OUTCOME MEASURES: The primary outcomes are 1 year and 2 year rates of mortality and re-hospitalisation for CHF. RESULTS: The 1 year mortality rate was numerically higher in the 2016 cohort at 10.3% (95% CI 9.9 to 10.7) versus 8.9% (CI 7.4 to 10.3; p=0.068). The 2 year mortality rate was significantly higher in the 2016 cohort at 14.5% (CI 13.9 to 15.1) versus 11.4% (CI 9.2 to 13.6; p<0.01). The 1 year rehospitalisation for CHF was lower in the 2016 cohort at 10.6% (CI 10.0 to 11.2) versus 16.7% (CI 14.0 to 19.4; p<0.001), but the 2 year rate was not significantly different at 19.3% (CI 17.7 to 20.9) versus 20.7% (CI 16.4 to 24.9; p=0.55). After adjustment for covariates with two models, the 1 year mortality increased by 2.3% (CI 0.8 to 3.7; p<0.01) and 4.1% (CI 2.6 to 5.6; p<0.001) in the 2016 cohort. The 2 year adjusted mortality also increased by 4.2% (CI 2.0 to 6.4; p<0.001) and 6.5% (CI 4.2 to 8.7; p<0.001) in the 2016 cohort. The risk adjusted trends for rehospitalisation for CHF were similar to the unadjusted findings. CONCLUSIONS: Despite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in Medicare beneficiaries with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.
Jack L. Martin (Thu,) conducted a cohort in Anterior ST-segment elevation myocardial infarction (STEMI) (n=23,911). Primary PCI in 2016-2017 vs. Primary PCI in 2005 was evaluated on 1-year mortality (Adjusted absolute increase 2.3%, 95% CI 0.8 to 3.7, p=<0.01). In Medicare beneficiaries with anterior STEMI, 1-year adjusted mortality increased by 2.3% (95% CI 0.8-3.7; p<0.01) in the 2016-2017 cohort compared to the 2005 cohort.
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