Abstract 238: Early Or Delayed Percutaneous Coronary Intervention For Non-st-elevation Myocardial Infarction In Pneumonia: Analysis From California State Inpatient Database (2006-2011)

Objective: Evaluate the safety of performing PCI for NSTEMI within 2 days compared to 2-7 days in patients admitted with pneumonia.

Background: The gold standard for detecting coronary atherosclerotic plaque in NSTEMI continues to be PCI. The need for providing lifesaving procedures such as stent placement for NSTEMI in patients admitted with pneumonia early, within 2 days, has not been evaluated.

Methods: We performed a retrospective analysis using California State Inpatient Database from years 2006-2011 to identify patients with a diagnosis of pneumonia present on admission (ICD-9-CM code 480-487) and a secondary diagnosis of NSTEMI (ICD-9-CM code 410.7) using the International Classification of Diseases, 9th edition codes. We compared the primary outcome of in-hospital mortality for patients that received PCI within 2 days of admission (early group) to those who received it between 2-7 days of admission (late group). We used a multivariable logistic regression model and adjusted for demographical characteristics, co-morbidities and severity of disease as identified by different organ failures. We also added propensity score to identify the probability that a patient would receive early PCI to the above model to increase its robustness.

Results: Between 2006-2011, we identified 4980 patients in the database who were admitted with pneumonia and developed NSTEMI who underwent PCI within 7 days. A total of 1809 patients underwent PCI in early group and 3171 underwent PCI in late group. In-hospital mortality was significantly higher in early PCI group (6.5% vs 4.1%, p < 0.001) when compared to late PCI. Of those who underwent PCI, 1142 (36%) received stents in early group while only 518 (28.6%) received stent in late group (p < 0.001). Propensity adjusted multiple logistic regression analysis showed higher odds of death in early group when compared to late group (OR 1.70, 95%CI 1.26-2.29, p < 0.001).

Conclusions: Patients admitted with pneumonia undergoing PCI within 48 hours for NSTEMI had higher mortality in comparison to those patients that underwent PCI within 2-7 days. Timing for PCI should be delayed beyond the first 48 hours in order to reduce the risk for complications and mortality in this patient population.