Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States,2001-2011

Background: little is known whether time trends of in-hospital mortality and costs of care for acute myocardial infarction (ami) differ by type of ami (st-elevation myocardial infarction [stemi] vs. non-st-elevation [nstemi]) and by the intervention received (percutaneous coronary intervention [pci],coronary artery bypass grafting [cabg],or no intervention) in the united states.methods and results: we conducted a serial cross-sectional study of all hospitalizations for ami aged 30 years or older using the nationwide inpatient sample,2001-2011 (1,456,154 discharges; a weighted estimate of 7,135,592 discharges). hospitalizations were stratified by type of ami and intervention,and the time trends of in-hospital mortality and hospital costs were examined for each combination of the ami type and intervention,after adjusting for both patient- and hospital-level characteristics. compared with 2001,adjusted in-hospital mortality improved significantly for nstemi patients in 2011,regardless of the intervention received (pci odds ratio [or] 0.68,95% ci 0.56 to 0.83; cabg or 0.57,0.45 to 0.72; without intervention or 0.61,0.57 to 0.65). as for stemi,a decline in adjusted in-hospital mortality was significant for those who underwent pci (or 0.83; 0.73 to 0.94); however,no significant improvement was observed for those who received cabg or without intervention. hospital costs per hospitalization increased significantly for patients who underwent intervention,but not for those without intervention.conclusions: in the united states,the decrease in in-hospital mortality and the increase in costs differed by the ami type and the intervention received. these non-uniform trends may be informative for designing effective health policies to reduce the health and economic burdens of ami. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.