Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO02 - Poster Session II (ID 47) Poster

D-PO02-122 - Comparison Of In-hospital Outcomes Of Post-PCI Ischemic Stroke After ST-elevation Myocardial Infarction In Patients With And Without Atrial Fibrillation From The National Inpatient Sample (ID 1017)

Disclosure
 S. Patil: Nothing relevant to disclose.

Abstract

Background: Atrial fibrillation (AF) has been associated with increased risk of ischemic stroke (IS) after percutaneous coronary intervention (PCI).
Objective: We sought to evaluate the differences in clinical outcomes in patients with and without AF hospitalized for ST-elevation myocardial infarction (STEMI) who developed IS after PCI.
Methods: Patients admitted with STEMI who underwent PCI from the National Inpatient Sample Database from January 1, 2010, through December 31, 2014 were identified. In this nationwide cohort study, we compared the prevalence, in-hospital mortality, length of hospital stay (LOS), cost and discharge disposition in patients with and without AF who developed post-PCI IS. Multivariate logistic and linear regression models were used to assess the effect of AF on in-hospital mortality, LOS and cost.
Results: This study comprised of 609,643 patients with STEMI who underwent PCI. The prevalence (per 1000) of post-PCI IS was 13.71% and 4.45% in patients with (n= 52,310) and without (n=557,333) AF respectively (p<0.001).In-hospital mortality after ischemic stroke was higher (49% vs. 36.8; p<0.001) in the AF cohort (Mean [SD] age: 74.7 [10.7] years; Female: 49.8%; Caucasian: 69.8%) compared to non-AF cohort (Mean [SD] age: 64.2 [12.2] years; Female: 40.1%; Caucasian: 58.9%). Among patients who developed IS, presence of AF was not associated with increased in-hospital mortality (aOR=0.935; 95%CI= 0.742-1.18; p=0.57), but was independently associated with longer LOS( Median [IQR] : 8 [5,11] vs. 6 [4,10] days; aOR =1.19; 95% CI = 1.08-1.23; p<0.001) and increased costs ( Median [IQR]: $ 119,045 [85397, 185363] vs. $ 115202 [76360, 185070]; aOR =1.13; 95% CI= 1.03-1.15;p=0.003). After IS, patients were less frequently discharged home in the AF cohort (29% vs. 43.8%; p<0.001).
Conclusion: In our study, STEMI patients with AF who developed post-PCI IS had poor outcomes, but, AF did not independently increase risk of in-hospital mortality.
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