AHJ: State-required reporting leads to less revascularization

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New York patients with acute MI and cardiogenic shock were less likely to undergo coronary angiography and PCI, and waited significantly longer to receive CABG than their non–New York counterparts, in a propensity-adjusted analysis published in the February issue of the American Heart Journal.

Researchers concluded that the findings suggest that state-required reporting to the New York State Cardiac Surgery and Percutaneous Coronary Intervention Reporting System may result in the reluctance to revascularize the highest-risk cardiac patients.

Renato A. Apolito, MD, of the department of cardiology at New York University School of Medicine in New York City, and colleagues, performed a retrospective analysis of 545 U.S. patients with acute MI and cardiogenic shock due to predominant left ventricular failure enrolled in the SHOCK Registry.

The researchers adjusted for case mix using a propensity score method, and compared the use of coronary angiography, PCI, CABG and outcomes between 220 patients in N.Y. and 325 in other states.

Overall, the N.Y. patients were older with similar or less severe baseline characteristics. After propensity score adjustment, the researchers found that N.Y. patients were less likely than non–New York patients to undergo coronary angiography and PCI.

Also, CABG rates were similarly low (14.1% vs. 15.1%), according to the authors. However, Apolito and colleagues found that N.Y. patients waited significantly longer after shock onset for surgery (101.2 vs. 10.3 hours) with only 32.3% of N.Y. patients vs. 75.5% of non–N.Y. patients taken for CABG within three days of shock onset.

The investigators noted that there was no significant difference in propensity-adjusted in-hospital mortality for New York vs. non–New York patients who were revascularized.

The researchers found that although PCI and CABG (both reportable procedures) differed between New York and non–New York patients, nonreportable procedures like IABP and right heart catheterization were used at least as often in New York. “These findings support the conclusion that a case selection bias influenced New York operators,” the authors wrote.