Author + information
- Cortes G. Andres,
- Jiken Bhatt,
- Nazila Rad,
- Han Tun,
- David Shavelle,
- Anilkumar Mehra,
- Michael A. Gaglia Jr.,
- Ray V. Matthews and
- Leonardo Clavijo
The goal of this study is to investigate baseline risk factors, angiographic characteristics, interventional procedural information and hospital outcomes in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) according to insurance status.
Recent studies demonstrate that patients with government-sponsored insurance and no insurance have worse cardiovascular outcomes than patients with private insurance after PCI. Additionally, insurance status has a significant impact in the decision to use drug-eluting or bare-metal stents. The effect of insurance type in patients undergoing PCI for the treatment of AMI is not known.
Baseline demographics, clinical characteristics, PCI procedural information and hospital outcomes were investigated in 771patients with AMI (STEMI and NSTEMI) treated at the Los Angeles County Hospital + USC Medical Center and Keck Medical Center of USC between January 2008 and June 2011. Patients were divided into 3 groups according to insurance type: Uninsured (n=301), government sponsored (n= 399, including Medicare and Medicaid), and private (n=71).
Uninsured compared to government sponsored and private insurance patients were younger (54.2±7.5 vs. 62.7±12 vs. 58.2±10.9, p<0.0001), more likely Hispanic (59.8% vs. 17.95% vs. 33.8%, p<0.0001), had higher total cholesterol (189.5±56 vs. 163.8±47 vs. 175.3±54.1 mg/dL, p<0.0001), more likely to have metabolic syndrome (54.5% vs. 42.5% vs. 50%, p=0.05), and had lower rates of renal insufficiency (2.1% vs. 10.8% vs. 12.1%, p<0.0001). There was no difference in DES use between the groups (46.7% vs. 42.7% vs. 43.4%, p=0.84). Cardiogenic shock on presentation (14.8% vs. 12.8% vs. 4.7%, p<0.0001), and in-hospital mortality (7.9% vs. 6.4% vs. 1.8%, p<0.001) were highest in the government-sponsored group followed by private and uninsured groups.
This study demonstrates that insurance type is associated with significant differences at baseline (clinical, demographic and procedural characteristics) and hospital outcomes in patients with AMI with PCI.
- 2013 American College of Cardiology Foundation