A-23 | PCI and sex disparities in cancer and thrombocytopenia: Propensity score and machine learning analysis of 101 million+ hospitalizations

BackgroundThrombocytopenia (TP) in patients with active cancer and acute myocardial infarction (AMI) often complicates optimal inpatient management, based on percutaneous coronary intervention (PCI) versus medical management, and few studies have analyzed related outcomesMethodsThis case-control study is the first nationally representative analysis of mortality, cost, and procedural volume in the above patient group. It utilized the United States largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted, weighted by the NIS complex survey design, and adjusted for known confounders (including NIS-calculated mortality risk by DRG and the likelihood of undergoing PCI versus medical management)ResultsAmong 101,521,656 hospitalizations, 2,280,554 (2.25%) had active cancer with AMI and 1,360,097 (1.34%) underwent PCI, of whom 220,558 (16.22%) had TP. The rate of PCI decreased with each subsequent year (30.33 versus 15.17 versus 14.14%) with comparable reduction for both TP and non-TP. AMI cancer patients with versus without TP across all years were significantly less likely to receive PCI (13.96 versus 20.66%, p<0.001), despite comparable mortality (21.13 versus 30.33%, p=0.094) when matched for age and mortality risk. Females with TP were also significantly less likely to receive PCI compared to male patients with TP (28.68 versus 39.87%, p<0.001). In multivariable regression, TP versus non-TP did not increase PCI mortality (OR 0.92, 95%CI 0.46-1.84; p=0.809) nor cost ($-7,168.64, 95%CI -30236.18-15898.91, p=0.542)ConclusionsThis study suggests PCI can provide comparable safety and cost for AMI cancer patients with or without thrombocytopenia, though this procedure is done less often for those with it particularly femalesDisclosuresC. A. Simbaqueba Clavijo Nothing to disclose. D. J. Monlezun Nothing to disclose. K. A. Honan Nothing to disclose. J. W. Kim Nothing to disclose. A. Badalamenti Nothing to disclose. V. Liu Nothing to disclose. A. Javaid Nothing to disclose. N. Palaskas Nothing to disclose. G. Iliescu Nothing to disclose. M. Cilingiroglu Nothing to disclose. K. Marmagkiolis Nothing to disclose. C. A. Iliescu Nothing to disclose. BackgroundThrombocytopenia (TP) in patients with active cancer and acute myocardial infarction (AMI) often complicates optimal inpatient management, based on percutaneous coronary intervention (PCI) versus medical management, and few studies have analyzed related outcomes Thrombocytopenia (TP) in patients with active cancer and acute myocardial infarction (AMI) often complicates optimal inpatient management, based on percutaneous coronary intervention (PCI) versus medical management, and few studies have analyzed related outcomes MethodsThis case-control study is the first nationally representative analysis of mortality, cost, and procedural volume in the above patient group. It utilized the United States largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted, weighted by the NIS complex survey design, and adjusted for known confounders (including NIS-calculated mortality risk by DRG and the likelihood of undergoing PCI versus medical management) This case-control study is the first nationally representative analysis of mortality, cost, and procedural volume in the above patient group. It utilized the United States largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted, weighted by the NIS complex survey design, and adjusted for known confounders (including NIS-calculated mortality risk by DRG and the likelihood of undergoing PCI versus medical management) ResultsAmong 101,521,656 hospitalizations, 2,280,554 (2.25%) had active cancer with AMI and 1,360,097 (1.34%) underwent PCI, of whom 220,558 (16.22%) had TP. The rate of PCI decreased with each subsequent year (30.33 versus 15.17 versus 14.14%) with comparable reduction for both TP and non-TP. AMI cancer patients with versus without TP across all years were significantly less likely to receive PCI (13.96 versus 20.66%, p<0.001), despite comparable mortality (21.13 versus 30.33%, p=0.094) when matched for age and mortality risk. Females with TP were also significantly less likely to receive PCI compared to male patients with TP (28.68 versus 39.87%, p<0.001). In multivariable regression, TP versus non-TP did not increase PCI mortality (OR 0.92, 95%CI 0.46-1.84; p=0.809) nor cost ($-7,168.64, 95%CI -30236.18-15898.91, p=0.542) Among 101,521,656 hospitalizations, 2,280,554 (2.25%) had active cancer with AMI and 1,360,097 (1.34%) underwent PCI, of whom 220,558 (16.22%) had TP. The rate of PCI decreased with each subsequent year (30.33 versus 15.17 versus 14.14%) with comparable reduction for both TP and non-TP. AMI cancer patients with versus without TP across all years were significantly less likely to receive PCI (13.96 versus 20.66%, p<0.001), despite comparable mortality (21.13 versus 30.33%, p=0.094) when matched for age and mortality risk. Females with TP were also significantly less likely to receive PCI compared to male patients with TP (28.68 versus 39.87%, p<0.001). In multivariable regression, TP versus non-TP did not increase PCI mortality (OR 0.92, 95%CI 0.46-1.84; p=0.809) nor cost ($-7,168.64, 95%CI -30236.18-15898.91, p=0.542) ConclusionsThis study suggests PCI can provide comparable safety and cost for AMI cancer patients with or without thrombocytopenia, though this procedure is done less often for those with it particularly females This study suggests PCI can provide comparable safety and cost for AMI cancer patients with or without thrombocytopenia, though this procedure is done less often for those with it particularly females