Abstract 17512: Differences in Hospital Risk-standardized Mortality Rates for Percutaneous Coronary Intervention by Patient Age Group: Implications for Hospital Outcome Profiling

Introduction: Hospital 30-day risk-standardized mortality rates (RSMRs) for percutaneous coronary intervention (PCI), a marker of PCI quality, are only calculated for Medicare beneficiaries ≥65 years-old. Whether these data also reflect hospital PCI quality for younger patients is unknown. Hypothesis: Hospital 30-day RSMRs for older patients ≥65 years-old undergoing PCI strongly correlate with 30-day RSMRs for younger patients Methods: We examined all PCI hospitalizations from 12/1/2011 to 11/30/2012 in the NCDR CathPCI registry linked to the National Death Index with direct identifiers. Hospital 30-day RSMRs for older and younger patients were calculated using two measures of 30-day mortality after PCI endorsed by the National Quality Forum. One was designed for patients with STEMI and/or cardiogenic shock (STEMI/shock) and the other was designed for patients without STEMI and without cardiogenic shock (no STEMI/no shock). We calculated the correlation of hospital 30-day RSMRs for older PCI patients with 30-day RSMRs for younger PCI patients among hospitals with ≥25 PCI patients in each age group for both STEMI/shock and no STEMI/no shock cohorts. Results: We identified 112,429 and 524,702 PCI hospitalizations with and without STEMI/shock, respectively (1357 hospitals). Median hospital 30-day RSMRs were 12.3% and 4.4% for older and younger PCI patients with STEMI/shock and 1.3% and 0.4% for older and younger PCI patients with no STEMI/no shock. Hospital 30-day RSMRs for older PCI patients were weakly correlated with 30-day RSMRs for younger PCI patients in both STEMI/shock and no STEMI/no shock cohorts (Pearson R=0.25 and 0.20, respectively) (Figure). Conclusions: Hospital 30-day RSMRs for older patients undergoing PCI poorly correlate with 30-day RSMRs for younger patients. Hospital outcomes for Medicare beneficiaries should therefore not be assumed to reflect hospital quality for all patient groups.