Abstract 711: In Hospital Complications After PCI After Insertion of DES versus BMS in the United States
Background: We evaluated the potential differences in patient complications and in-hospital mortality for patients who underwent primary percutaneous coronary intervention (PCI) with insertion of drug-eluting coronary artery stent (DES) versus those with insertion of bare metal stent (BMS) in the United States.
Method: We used the Nationwide Inpatient Sample to examine differences in all-cause in-hospital mortality between DES versus BMS patients with a principal diagnosis of STEMI, NSTEMI and Coronary atherosclerosis ICD-9 codes. Bivariate and adjusted logistic regression analysis were used to identify any associations with DES versus BMS with increased subsequent complications and in-hospital mortality.
Results: We identified 9140 admissions with PCI as a primary intervention, of which 85.03% native coronary artery stenosis, 5.9% presented with NSTEMI, 4.9% had STEMI, and 4.0% revascularized due to graft stenosis. Patients with graft stenosis and STEMI had the highest rates of BMS insertion (62% and 49% respectively).
The odds of in-hospital mortality were higher for BMS insertion among all for different group. However, the association lost the statistical significance after adjusting for patient characteristics, except for patients with native coronary artery stenosis (OR =1.96 95% CI: 1.02-3.8).
Major complications, including vascular, neurological, and mechanical complications were higher for BMS insertion for NSTEMI and graft coronary atherosclerosis patients. However, BMS insertion associated with less complication in STEMI patients and native coronary atherosclerosis. the later didn’t reach the statistical significance level. Interestingly, there was no in-hospital mortality in our sample among male with DES insertion.
Conclusion: The clinical context of PCI and choice of DES versus BMS, with BMS a preferential choice in patients with evidence of thrombus (STEMI) is reflected in downstream complications and in-hospital mortality.
Author Disclosures: M. Khoshchehreh: None.
- © 2015 by American Heart Association, Inc.