NCDR Study Finds Moderate Correlation Between Procedure, Disease-Based Mortality

Among hospitals treating patients with acute myocardial infarction (AMI) and performing PCI, there may be a moderate correlation between procedural and disease-based outcomes, according to a study recently published in JAMA Cardiology.

Ashwin S. Nathan, MD, et al., used data from ACC's CathPCI Registry and Chest Pain – MI Registry to assess hospital-level correlations between disease-based AMI mortality and PCI procedural mortality among AMI patients at hospitals participating in both registries. The researchers also looked at whether hospital performance would be reclassified based on disease-based mortality vs. procedural mortality.

The study's primary outcomes were excess mortality ratios of STEMI and NSTEMI patients for both registries. The excess mortality ratio represents the risk-adjusted observed to expected mortality rate for AMI patients, with AMI as disease-based mortality for the Chest Pain – MI Registry and PCI for procedure-based mortality for the CathPCI Registry.

The final cohort consisted of 625 sites participating in both registries, with 853,386 patients in the CathPCI Registry and 776,890 patients in the Chest Pain – MI Registry. Among CathPCI Registry patients, 368,940 (43.2%) underwent PCI for STEMI and 484,446 (56.8%) underwent PCI for NSTEMI. Among Chest Pain – MI Registry patients, 292,657 (37.7%) presented with STEMI and 484,233 (62.3%) presented with NSTEMI. Among these, 263,727 (90.1%) and 258,371 (53.4%) underwent PCI for STEMI and NSTEMI, respectively.

Among linked hospitals, there was a moderate correlation between disease-based and procedure-based mortality (ratio = 0.53; confidence interval [CI], 0.47 to 0.58). In the highest-performing tertile for disease-based risk-adjusted mortality, 118 of 208 sites (56.7%) were also in the highest tertile for procedure-based risk-adjusted mortality, while 90 sites (43.3%) were in a lower category for procedure risk-adjusted mortality. Among the lowest-performing tertile for disease-based risk-adjusted mortality, 116 of 208 sites (55.8%) were also in the lowest tertile for procedure-based risk-adjusted mortality. Of these sites, 92 (44.2%) were in a higher category for procedure-based risk-adjusted mortality.

In terms of excess mortality ratios, procedure-based mortality was higher than disease-based mortality, with a mean difference of 0.49% (95% CI, –1.61% to 2.58%; p<0.001). However, among patients with AMI complicated by cardiogenic shock or cardiac arrest, the mean difference was –0.64% (95% CI, –4.41% to 3.12%; p<0.001).

According to the researchers, there is only a moderate correlation between PCI outcomes and AMI outcomes for hospitals treating AMI patients. Although the findings show higher procedural vs. disease-based mortality across the entire AMI cohort, higher mortality rates among patients with cardiogenic shock or cardiac arrest when using disease-based vs. procedural metrics "may represent potential risk avoidance among this highest-risk subset of patients," they conclude.

Keywords: ST Elevation Myocardial Infarction, Shock, Cardiogenic, Benchmarking, Percutaneous Coronary Intervention, Myocardial Infarction, Chest Pain, Registries, Outcome Assessment, Health Care, Heart Arrest, Cardiology, Cohort Studies, National Cardiovascular Data Registries, CathPCI Registry, Chest Pain MI Registry


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