Relationship of Hospital Teaching Status with In-Hospital Outcomes for ST-Segment Elevation Myocardial Infarction

Tanush Gupta, Kavisha Patel, Dhaval Kolte, Sahil Khera, Pedro A. Villablanca, Wilbert S. Aronow, William H. Frishman, Howard A. Cooper, Anna E. Bortnick, Gregg C. Fonarow, Julio A. Panza, Giora Weisz, Mark A. Menegus, Mario J. Garcia, Deepak L. Bhatt

Research output: Contribution to journalArticle

Abstract

Background: Prior analyses have largely shown a survival advantage with admission to a teaching hospital for acute myocardial infarction. However, most prior studies report data on patients hospitalized over a decade ago. It is important to re-examine the association of hospital teaching status with outcomes of acute myocardial infarction in the current era. Methods: We queried the 2010 to 2014 National Inpatient Sample databases to identify all patients aged ≥18 years hospitalized with the principal diagnosis of ST-segment elevation myocardial infarction (STEMI). Multivariable logistic regression models were constructed to compare rates of reperfusion and in-hospital outcomes between patients admitted to teaching vs nonteaching hospitals. Results: Of 546,252 patients with STEMI, 273,990 (50.1%) were admitted to teaching hospitals. Compared with patients admitted to nonteaching hospitals, those at teaching hospitals were more likely to receive reperfusion therapy during the hospitalization (86.7% vs 81.5%; adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.39-1.44; P <.001) and had lower risk-adjusted in-hospital mortality (4.9% vs 6.9%; adjusted OR 0.84; 95% CI, 0.82-0.86; P <.001). After further adjustment for differences in use of in-hospital reperfusion therapy, the association of teaching hospital status with lower risk-adjusted in-hospital mortality was significantly attenuated but remained statistically significant (adjusted OR 0.97; 95% CI, 0.94-0.99; P =.02). Conclusions: Patients admitted to teaching hospitals are more likely to receive reperfusion and have lower risk-adjusted in-hospital mortality after STEMI compared with those admitted to nonteaching hospitals. Our results suggest that hospital performance for STEMI continues to be better at teaching hospitals in the contemporary era.

Original languageEnglish (US)
Pages (from-to)260-268.e1
JournalAmerican Journal of Medicine
Volume131
Issue number3
DOIs
StatePublished - Mar 2018

Keywords

  • In-hospital mortality
  • Reperfusion therapy
  • ST-segment elevation myocardial infarction
  • Teaching hospital

ASJC Scopus subject areas

  • Medicine(all)

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    Gupta, T., Patel, K., Kolte, D., Khera, S., Villablanca, P. A., Aronow, W. S., Frishman, W. H., Cooper, H. A., Bortnick, A. E., Fonarow, G. C., Panza, J. A., Weisz, G., Menegus, M. A., Garcia, M. J., & Bhatt, D. L. (2018). Relationship of Hospital Teaching Status with In-Hospital Outcomes for ST-Segment Elevation Myocardial Infarction. American Journal of Medicine, 131(3), 260-268.e1. https://doi.org/10.1016/j.amjmed.2017.09.047