In nonagenarians with STEMI, primary PCI was associated with higher odds of unplanned 30-day readmission (aOR 1.25; 95% CI 1.12-1.39) but lower in-hospital mortality (aOR 0.51) compared to no pPCI.
Cohort (n=58,231)
Yes
Does primary percutaneous coronary intervention improve mortality and readmission rates in nonagenarians with STEMI?
In nonagenarians with STEMI, primary PCI is associated with a significant reduction in in-hospital and 30-day mortality, despite a slightly higher rate of 30-day readmission.
Odds Ratio: 1.25 (95% CI 1.12–1.39)
Absolute Event Rate: 21% vs 15.4%
p-value: p=<0.001
OBJECTIVES: To assess readmission rates in nonagenarians (age ≥ 90 years) with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI. BACKGROUND: There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI. METHODS: We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30-day readmission, readmission rates, and causes of readmissions. RESULTS: We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30-day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30-day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30-day readmission (adjusted odds ratio aOR: 1.25, 95% confidence interval CI: 1.12-1.39, p < 0.001) and 49% lower odds of in-hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46-0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction. CONCLUSIONS: In nonagenarians with STEMI, pPCI is associated with slightly higher 30-day readmission but significantly lower mortality during index hospitalization and during 30-day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.
Ismayl et al. (Sat,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=58,231). Primary percutaneous coronary intervention (pPCI) vs. No pPCI was evaluated on Unplanned 30-day readmission (aOR 1.25, 95% CI 1.12-1.39, p=<0.001). In nonagenarians with STEMI, primary PCI was associated with higher odds of unplanned 30-day readmission (aOR 1.25; 95% CI 1.12-1.39) but lower in-hospital mortality (aOR 0.51) compared to no pPCI.