Effect of insurance type on adverse XXXX after percutaneous coronary intervention.

@entity1 @entity583 @entity204 @entity299
Previous studies have documented disparities in both access to invasive cardiovascular procedures and outcomes in @entity1 with Medicaid, Medicare, or no insurance. Outcomes by insurance have yet not been examined in a percutaneous coronary intervention (PCI) population. Data from @entity1 undergoing PCI from June 2000 to June 2009 were retrospectively analyzed. Insurance was categorized as private, Medicare, Medicaid, and uninsured, according to the primary insurance at discharge. The outcome variable of interest was major adverse @entity299 (a composite of @entity204 , Q-wave @entity583 , and target vessel revascularization) at 1 year. Multivariable Cox regression analysis was stratified according to age <65 and >= 65 years. Of the 13,573 @entity1 who had undergone PCI, 6,653 (49.0%) had private insurance, 6,150 (45.3%) had Medicare, 486 (3.6%) had Medicaid, and 284 (2.1%) were uninsured. Of the @entity1 <65 years old, Medicaid (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.04 to 2.43), Medicare (HR 2.18, 95% CI 1.58 to 2.99), and no insurance (HR 2.41, 95% CI 1.36 to 4.27) were associated with greater rates of adjusted major adverse @entity299 at 1 year compared with private insurance. Of the @entity1 >= 65 years old, only Medicaid (HR 3.07, 95% CI 1.09 to 8.61) was associated with a greater rate of adjusted major adverse @entity299 at 1 year. In conclusion, @entity1 with government-sponsored insurance and no insurance have worse cardiovascular outcomes than @entity1 with private insurance after PCI at 1 year. This implies that the provision of health insurance alone might not have a dramatic effect on cardiovascular outcomes after PCI.
