(39) Treatment, Testing, and Outcomes from ST-elevation Myocardial Infarction (STEMI) at an Academic Healthcare System: A Retrospective Analysis

Background: : Acute coronary syndrome, particularly ST-elevation Myocardial Infarction (STEMI), imposes a lifelong treatment and financial burden on patients in the United States due to high incidence, intensive interventions, and risk of recurrent adverse cardiac events.

Objective: : To describe healthcare resource utilization for STEMI patients receiving Percutaneous Coronary Intervention (PCI).

Methods: : Adult patients who received PCI for STEMI at the University of Utah between 1/1/2017 and 12/31/2023 were included. Patient identification and data collection occurred within National Cardiovascular Data Registries and electronic medical records. Descriptive statistics were used to analyze care received during the hospitalization for PCI and at 5 years post-discharge. High-risk subgroups by TIMI flow grade and infarct location were also assessed.

Results: : A total of 781 patients (mean (SD) age 63 (13)) were eligible, most were male (73%), White (94%), and had private insurance (66%). Upon hospital admission for PCI, patients had a median (IQR) BMI of 29 (25-33) kg/m2, heart rate of 79 (66-93), and mean (SD) systolic BP of 145 (32). Current smokers accounted for 27% of the cohort, while 37% were never smokers. A history of heart failure (HF) was seen in 13% of patients. Other common comorbidities at baseline included hypertension (60%), dyslipidemia (51%), and obesity (42%). During hospitalization, patients (>90%) received anticoagulants, antiplatelets, P2Y12 inhibitors, aspirin, long-acting nitrates, statins, and antiplatelets, individually. Patients spent a median (IQR) of 3 (2-4) days in emergency care and 5% received a coronary artery bypass graft (CABG) in addition to PCI. Pre-PCI TIMI grade of 0-1 was present in 428 patients (55%) and 305 patients (39%) had an anterior wall infarction. At 5 years post-discharge, the most common medications were antiplatelets (81%), P2Y12 inhibitors (77%), beta blockers (73%), and statins (69%). HF-related office visits and hospitalizations were 13% and 7%, respectively. Among patients with pre-PCI TIMI grades of 0-1, rates of office visits and hospitalizations for HF increased to 16% and 7%, respectively, and among patients with an anterior wall infarction, rates of these same encounters increased to 20% and 10%, respectively.

Conclusions: : HF-related encounters post-discharge were high among patients with STEMI who received PCI, especially in subgroups with pre-PCI TIMI grades of 0-1 or anterior wall infarctions. This highlights an opportunity for clinical interventions to prevent HF within this population.

Sponsorship:: Boehringer Ingelheim