Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among US Hospitals.

Background: There may be variability in willingness to perform percutaneous coronary intervention (PCI) in higher-risk patients who present with ST-segment-elevation myocardial infarction (STEMI). We sought to describe current treatment selection patterns and hospital-level variability.

Methods And Results: We identified patients presenting with STEMI with a culprit lesion on coronary angiography between January 1, 2019, and March 31, 2023, using the NCDR (National Cardiovascular Data Registry) CPMI (Chest Pain-Myocardial Infarction) registry. We compared patient-level characteristics of patients who did and did not undergo PCI at each hospital. There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. Among patients with STEMI and a culprit lesion, 6180 did not undergo PCI (3.5%). Patients with a presentation of STEMI and a culprit lesion who did not undergo PCI were older (67 [interquartile range, 58-76]) years versus 62 ([interquartile range, 54-71] years, <0.001), more likely to present with heart failure (15.0% versus 7.4%, <0.001), and more likely to have cardiac arrest before arrival (9.7% versus 5.1%, <0.001) than patients who underwent PCI. Patients who did not undergo PCI had higher predicted mortality rates (12.5%±17.9% versus 6.5%±11.5%, <0.001) and observed mortality rates (21.7% versus 6.4%, <0.001) compared with patients who underwent PCI.

Conclusions: There is variability in the percentage of patients with culprit lesions on invasive coronary angiography undergoing PCI for STEMI, with 3.5% of patients with STEMI not receiving PCI overall, and >5% of patients not undergoing PCI in a quarter of US hospitals. Differences in observed versus predicted mortality rates for patients who did or did not undergo PCI may highlight the effects of risk-avoidant behavior.