Comparative Outcomes of Percutaneous Coronary Intervention in Academic Versus Non-Academic Institutions: Insights from a Nationwide Cohort Analysis
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Introduction
Percutaneous Coronary Intervention (PCI) is a cornerstone in managing coronary artery disease. Outcomes may vary by institutional settings, with academic centers often treating higher-risk cases. This study compares adverse PCI outcomes between academic and non-academic hospitals using real-world data.
Objectives
Comparison of adverse outcome of PCI in academic versus non-academic setting using real-world data. We hypothesize that academic centers despite their specialized capabilities, exhibit higher adverse event rates due to the complexity of cases and patient risk profiles.
Methods
A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Adults (35–90 years), who underwent PCI between Jan 1, 2010 to Jan 1, 2020 were included. Those with congenital heart disease, rheumatic heart disease, ischemic cardiomyopathy, or prior myocardial infarction (MI) were excluded. Groups were stratified by hospital academic status and balanced using 1:1 propensity score matching. Outcomes were assessed within 90 days post-PCI. Patients with a recorded occurrence of the outcome prior to the index event were excluded from each respective outcome analysis. Kaplan-Meier analysis and log-rank tests were used for statistical comparisons with significance set at p<0.05.
Results
Academic centers demonstrated significantly higher hazard ratios (HR) for multiple adverse outcomes. HRs (95% CI): all-cause mortality 1.465 (1.314–1.632), cardiac arrest 11.798 (5.453–25.526), complications in total 3.798 (3.065–4.707), systemic thromboembolism 2.052 (1.412–2.984), cerebrovascular infarction 4.028 (1.137–14.274), acute coronary thrombosis not resulting in MI 2.554 (1.405–4.643), Dressler’s syndrome/pericarditis 2.374 (1.346–4.187), coronary artery aneurysm or dissection 4.560 (3.029–6.866), injury to the radial or femoral artery 27.277 (3.707–200.732), acute kidney injury 3.266 (2.825–3.777), and hematomas/hemorrhages 3.835 (2.864–5.136). MI type 2/4 had a less definitive HR of 1.658 (0.853–3.221).
Conclusions
In this retrospective analysis of TriNetX data, for the majority of PCI associated outcomes, statistically significant higher rate of adverse outcomes in academic institution have been observed as compared to non-academic settings. These findings could be due to referral of high risk, and complex cases to academic centers. Future studies should investigate modifiable institutional factors and patient-level variables driving this disparity.
