1. PCI related in-hospital mortality based on race and gender in the USA
Mohammad Reza Movahed, MD, PhD, FSCAI, FACC, FACP
Associate Professor of Medicine
The Southern Arizona VA Health Care System
University of Arizona Sarver Heart Center
Section of Cardiology
Department of Medicine

2. Mohammad Reza Movahed, MD, PhD
DISCLOSURES
Mohammad Reza Movahed, MD, PhD
I have no real or apparent conflicts of interest to report.
I intend to reference unlabeled/unapproved uses of drugs or devices in my presentation.
I intend to reference contrast removal technology.

3. Background
Significant advances has been made in last few decades in regards to PCI techniques and pharmacological treatments
This should lead to a better outcome in patients undergoing PCI in the recent years

4. Goal of our study
The goal of this study was to evaluate age-adjusted in-hospital mortality rates in patients undergoing PCI, based on race and gender in a large population

5. Supporting Literature
Improved survival in PCI patients has been documented in England
PCI event free survival improved from
73% in 1995–1998 to
83% in 2001–2004
Blackledge HM, Squire IB. Improving long-term outcomes following coronary artery bypass graft or percutaneous coronary revascularisation: results from a large, population-based cohort with first intervention Heart 2009;95:

6. Literature
Recently published data from National Cardiovascular Data Registry reported lower in-hospital mortality rate from PCI in recent years
However, gender and race specific mortality has not been studied in a large population
Singh M, et al. Trends in the Association Between Age and In-Hospital Mortality After Percutaneous Coronary Intervention: National Cardiovascular Data Registry Experience. Circ Cardiovasc Intervent 2009;2:20-26

7. Method
We used the Nationwide Inpatient Sample (NIS) database to calculate the age-adjusted PCI related in-hospital mortality rates from 1988 to 2004 based on ICD-9 Codes in patients over the age of 40
Specific ICD-9-CM codes for PCIs were used for our study
Patient’s demographic data was also analyzed and adjusted for age from the database and reported based on race and gender

8. PCI related ICD-9 codes

9. Data Collection and Data Sources:
The Nationwide Inpatient Sample (NIS) is a component of the Healthcare Cost and Utilization Project (HCUP), which is sponsored by the Agency for Healthcare Research and Quality (AHRQ)
NIS involves approximate a 20-percent sample of U.S. community hospitals and other specialty hospitals.

10. Method
The NIS contains primary and secondary diagnoses, primary and secondary procedures, admission and discharge status, and patient demographics
The NIS database is composed of all-payer information on hospital inpatient admissions from participating States

11. Method
The average age-adjusted in-hospital mortality rates for PCI for each year were calculated by multiplying the age-specific mortality rates of PCI by age-specific weights
The weights used in the age-adjustment of the data were the proportion of the year 2000 standard U.S. population within each age group.
The weighted rates were for each year from 1988 to 2004 then summed across the age groups for the calculation of age-adjusted rate

12. NIS Participating states

13. NIS Hospitals by regions

14. Results Total number of coded PCI was 26,345
The mean age for these patients was ±10.59

15. Results
Age adjusted gender distribution of the study population was as following:
Male 53.4 %
Female 46.6 %

16. Race Distribution
In percent

17. Results for total population:
From 1988 the age-adjusted mortality rate was stable until 1995
From 1995 mortality declined steadily to lowest level in 2004

18. Age adjusted mortality rate

19. Age adjusted Mortality

20. Total mortality decline for PCI

21. Age adjusted mortality based on gender

22. PCI related mortality rate per 100,000

23. Age adjusted mortality based on race

24. Why better survival?
Increasing utilization of glycoprotein IIb/IIIa has been shown to improve outcome
Smaller sheath size for coronary intervention may have been contributed to lower bleeding
Technical advancement in PCI equipment such as improvement in stents and balloon design with lower crossing profile
Increasing utilization of radial access
Preloading of patients with clopidogrel and the increasing usage of bivalirudin

25. Higher Mortality in women and minorities?
Women at the same age in comparison to men have higher co-morbidities which may explain our finding
In a large study adjusting for baseline characteristic, female gender was not associated with higher PCI related mortality
Race related mortality from PCI has not been studied previously
Singh M, et al.. Mortality differences between men and women after percutaneous coronary interventions. A 25-year, single-center experience. J Am Coll Cardiol 2008;51:

26. Limitations:
ICD-9 coding has inherited diagnostic inaccuracy limiting our data
Changing in the diagnostic coding over the years may have influence the accuracy of our data.
We did not have data about stability and complications of our patients limiting our results to mortality outcomes only

27. Conclusion
The age adjusted PCI related in-hospital mortality has gradually decreased over recent years regardless of race or gender reflecting improvement in clinical care of patients undergoing PCI
However, higher PCI related mortality in women and minorities persisted over the years warranting further investigation