Study Analyzes Effect of Insurance Type on Adverse Events After PCI

December 24, 2010—Findings from a study on the effect of the type of insurance coverage patients have on adverse cardiac events after percutaneous coronary intervention (PCI) have been published by Michael Gaglia, MD, et al online ahead of print in the American Journal of Cardiology.

According to the investigators, previous studies have documented disparities in both access to invasive cardiovascular procedures and outcomes in patients with Medicaid, Medicare, or no insurance. However, outcomes by insurance have not yet been examined in a PCI population.

In this study, data from patients undergoing PCI from June 2000 to June 2009 were retrospectively analyzed. Insurance was categorized as private, Medicare, Medicaid, and uninsured, according to the patients' primary insurance at discharge. The outcome variable of interest was major adverse cardiac events (a composite of death, Q-wave myocardial infarction, and target vessel revascularization) at 1 year. A multivariable Cox regression analysis was stratified into two groups according to age: younger than 65 and 65 years and older.

The investigators reported that of the 13,573 patients who had undergone PCI, 6,653 (49%) had private insurance, 6,150 (45.3%) had Medicare, 486 (3.6%) had Medicaid, and 284 (2.1%) were uninsured. Of the patients who were younger than 65 years, Medicaid (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.04 –2.43), Medicare (HR, 2.18; 95% CI, 1.58–2.99), and no insurance (HR, 2.41; 95% CI, 1.36–4.27) were associated with greater rates of adjusted major adverse cardiac events at 1 year compared with private insurance. Of the patients who were 65 years or older, only Medicaid (HR, 3.07; 95% CI, 1.09–8.61) was associated with a greater rate of adjusted major adverse cardiac events at 1 year.

The investigators concluded that patients with government-sponsored insurance and no insurance have worse cardiovascular outcomes than patients with private insurance after PCI at 1 year. They stated that this implies that the provision of health insurance alone might not have a dramatic effect on cardiovascular outcomes after PCI.