Trends in Utilization and Safety of In-Hospital Coronary Artery Bypass Grafting During a Non-ST-Segment Elevation Myocardial Infarction

Elbaz‐Greener, Gabby; Rozen, Guy; Kusniec, Fabio; Marai, Ibrahim; Ghanim, Diab; Carasso, Shemy; Gavrilov, Yulia; Sud, Maneesh; Strauss, Bradley H.; Ko, Dennis T.; Wijeysundera, Harindra C.; Planer, David; Amir, Offer

doi:10.1016/j.amjcard.2020.08.019

“…Detailed information on the methods were provided in our prior study by Elbaz et al 16 Briefly, the data were drawn from the National Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ). 17 , 18…”

Section: Methodsmentioning

confidence: 99%

“…Detailed information on the methods were provided in our prior study by Elbaz et al 16 Briefly, the data were drawn from the National Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ). 17,18 The NIS database includes only de-identified data; therefore, this study was deemed exempt from institutional review by the Human Research Committee of Poriya Medical Center.…”

Section: Data Sourcementioning

confidence: 99%

The Relationship Between Body Mass Index and In-Hospital Mortality in the Contemporary Era of an Acute Myocardial Infarction Management

Elbaz‐Greener¹,

Rozen²,

Carasso³

et al. 2021

VHRM

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Background The association between body mass index (BMI) and clinical outcomes following an acute myocardial infarction (AMI) remains controversial. Our objective was to investigate the relationship between BMI and AMI presentation, in-hospital clinical course and mortality in the contemporary era of AMI management. Methods Patients, hospitalized for an AMI between October 2015 and December 2016, were identified in the National Inpatient Sample (NIS) database. Socio-demographic and clinical data, including BMI, were collected and outcomes, including length of stay and mortality, were analyzed. Patients were divided into 6 BMI (kg/m 2 ) subgroups; under-weight (≤19), normal-weight (20–25), over-weight (26–30), obese I (31–35), obese II (36–39) and extremely obese (≥40). Multivariable logistic regression model was used to identify predictors of in-hospital mortality. Linear regression model was used to identify predictors of length of stay (LOS). Results An estimated total of 125,405 hospitalizations for an AMI across the US were analyzed. Compared to the other BMI subgroups, the under-weight, normal-weight and extremely obese groups presented with a non-ST segment elevation AMI (NSTEMI) more frequently and were less likely to undergo coronary revascularization. The data show a J-shaped relationship between BMI and study outcomes with lower mortality in patients with BMI over 25 compared to normal- and low-weight patients. In the multivariate regression model, BMI group was found to be an independent predictor of mortality. Conclusion J-shaped relationship between BMI and mortality was documented in patients hospitalized for an AMI in the recent years. These findings confirm that the “obesity paradox” persists during the contemporary era of an AMI management.

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“…(1) The population of NSTEMI patients included in the current study is representative of other NSTEMI populations as described elsewhere based on data from the Dutch National Cardiac Registry, the National Cardiac Audit Program in the United Kingdom and nationwide databases from the USA. (10, 13,14) The currently studied approach has apparent improvement potential in reducing the amount of invasive procedures per patient, inter-hospital transfers and duration of hospitalisation, all of which are outcomes that have direct impact on patients. The societal impact is in costs and is associated with duplicate claims for the same condition by multiple providers.…”

Section: Discussionmentioning

confidence: 99%

“…In the CABG cohort, no difference was found between the hospitals in time from admission to ICA and performing an ICA within 24 hours [Time to ICA: 1 day (0-3) vs. 1 days (1-3), p= 0.348]; ICA <24h: 57.3% vs. 56.9%, p= 0.942]. In an intervention centre, time from admission to revascularisation was shorter than in a general hospital [8 days (5-12) vs. 10 days (7)(8)(9)(10)(11)(12)(13)(14)…”

Section: Cabg Cohortmentioning

confidence: 99%

Direct Admission Versus Interhospital Transfer for revascularisation in non-ST-Segment Elevation Myocardial Infarction

Steenbergen

¹

,

Demandt

²

,

Schulz

³

et al. 2022

Preprint

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Objective We aim to compare quality parameters, costs and clinical outcomes of NSTEMI patients stratified by centre of first presentation and revascularisation strategy. Methods Hospital claim data on patients admitted with a NSTEMI between 2017 and 2019 from one of the largest health insurers in the Netherlands were used for this study. Included patients were stratified by revascularisation strategy (PCI, CABG or no revascularisation [noRevasc]) and subdivided by centre of presentation per treatment. The primary outcomes were the following quality measures: duration between admission and revascularisation, length of hospital stay and number of intracoronary procedures. Total costs (accumulation of costs for hospital claims and inter-hospital ambulance rides) and clinical outcomes at 30 days (MACE: all-cause mortality, recurrent myocardial infarction and cardiac readmission) were used as secondary outcomes. Results A total of 9641 NSTEMI events (9167 unique patients) were analysed for which PCI was performed during admission in 4448 cases, CABG in 816 cases and no revascularisation was performed in 4377 cases. Direct presentation at an intervention centre occurred in 59%, 55% and 60% of cases, respectively. For PCI, direct presentation at an intervention centre yielded shorter time to revascularisation, shorter hospitalisation and less intracoronary procedures per patient. For CABG, time to revascularisation and hospitalisation were shorter. Total costs were significantly lower in case of direct presentation in an intervention centre for all treatment groups while MACE was similar. Conclusion Direct admission of NSTEMI patients to an intervention centre might yield improvement potential for current NSTEMI care.

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“…In an intervention centre, time from admission to revascularisation was shorter than in a general hospital [8 days (5)(6)(7)(8)(9)(10)(11)(12) vs. 10 days (7-14), p = < 0.001]. Total length of stay was shorter in an intervention centre compared to a general hospital [16 days (12)(13)(14)(15)(16)(17)(18)(19)(20)(21) vs. 18 days (14-23), p < 0.001]. In MACE, no difference was found between the hospitals [9.2% vs. 10.8%, p = 0.481].…”

Section: Cabg Cohortmentioning

confidence: 99%

The potential for improvement of quality parameters and reduction of costs in the current Non-ST Elevation Myocardial Infarction logistics

Steenbergen

¹

,

Demandt

²

,

Schulz

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Objective We aim to compare quality parameters, costs and clinical outcomes of NSTEMI patients stratified by centre of first presentation and revascularisation strategy. Methods Hospital claim data on patients admitted with a NSTEMI between 2017 and 2019 from one of the largest health insurers in the Netherlands were used for this study. Included patients were stratified by revascularisation strategy (PCI, CABG or no revascularisation [noRevasc]) and subdivided by centre of presentation per treatment. The primary outcomes were the following quality measures: duration between admission and revascularisation, length of hospital stay and number of intracoronary procedures. Total costs (accumulation of costs for hospital claims and inter-hospital ambulance rides) and clinical outcomes at 30 days (MACE: all-cause mortality, recurrent myocardial infarction and cardiac readmission) were used as secondary outcomes. Results A total of 9641 NSTEMI events (9167 unique patients) were analysed for which PCI was performed during admission in 4448 cases, CABG in 816 cases and no revascularisation was performed in 4377 cases. Direct presentation at an intervention centre occurred in 59%, 55% and 60% of cases, respectively. For PCI, direct presentation at an intervention centre yielded shorter time to revascularisation, shorter hospitalisation and less intracoronary procedures per patient. For CABG, time to revascularisation and hospitalisation were shorter. Total costs were significantly lower in case of direct presentation in an intervention centre for all treatment groups while MACE was similar. Conclusion Direct admission of NSTEMI patients to an intervention centre might yield improvement potential for current NSTEMI care.

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Trends in Utilization and Safety of In-Hospital Coronary Artery Bypass Grafting During a Non-ST-Segment Elevation Myocardial Infarction

Cited by 9 publications

References 26 publications

The Relationship Between Body Mass Index and In-Hospital Mortality in the Contemporary Era of an Acute Myocardial Infarction Management

The Relationship Between Body Mass Index and In-Hospital Mortality in the Contemporary Era of an Acute Myocardial Infarction Management

Direct Admission Versus Interhospital Transfer for revascularisation in non-ST-Segment Elevation Myocardial Infarction

The potential for improvement of quality parameters and reduction of costs in the current Non-ST Elevation Myocardial Infarction logistics

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