{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:14:23Z","timestamp":1766067263037,"version":"3.40.5"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T00:00:00Z","timestamp":1608249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["UL1 TR000135"],"award-info":[{"award-number":["UL1 TR000135"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>There are limited contemporary data on the influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction (STEMI).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objective<\/jats:title><jats:p>To assess the influence of insurance status on STEMI outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Methods<\/jats:title><jats:p>Adult (&gt;18 years) STEMI admissions were identified using the National Inpatient Sample database (2000\u20132017). Expected primary payer was classified into Medicare, Medicaid, private, uninsured and others. Outcomes of interest included in-hospital mortality, use of coronary angiography and percutaneous coronary intervention (PCI), hospitalization costs, hospital length of stay and discharge disposition.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Results<\/jats:title><jats:p>Of the 4,310,703 STEMI admissions, Medicare, Medicaid, private, uninsured and other insurances were noted in 49.0%, 6.3%, 34.4%, 7.2% and 3.1%, respectively. Compared to the others, the Medicare cohort was older (75 vs. 53\u201357 years), more often female (46% vs. 20\u201336%), of white race, and with higher comorbidity (all<jats:italic>p<\/jats:italic>&lt;0.001). The Medicare and Medicaid population had higher rates of cardiogenic shock and cardiac arrest. The Medicare cohort had higher in-hospital mortality (14.2%) compared to the other groups (4.1\u20136.7%), p&lt;0.001. In a multivariable analysis (Medicare referent), in-hospital mortality was higher in uninsured (adjusted odds ratio (aOR) 1.14 [95% confidence interval {CI} 1.11\u20131.16]), and lower in Medicaid (aOR 0.96 [95% CI 0.94\u20130.99];<jats:italic>p<\/jats:italic>= 0.002), privately insured (aOR 0.73 [95% CI 0.72\u20130.75]) and other insurance (aOR 0.91 [95% CI 0.88\u20130.94]); all<jats:italic>p<\/jats:italic>&lt;0.001. Coronary angiography (60% vs. 77\u201382%) and PCI (45% vs. 63\u201370%) were used less frequently in the Medicare population compared to others. The Medicare and Medicaid populations had longer lengths of hospital stay, and the Medicare population had the lowest hospitalization costs and fewer discharges to home.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Conclusions<\/jats:title><jats:p>Compared to other types of primary payers, STEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher in-hospital mortality.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0243810","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T19:23:40Z","timestamp":1608319420000},"page":"e0243810","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction in the United 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R.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan S.","family":"Jaffe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6353-6780","authenticated-orcid":true,"given":"Gregory W.","family":"Barsness","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,18]]},"reference":[{"key":"pone.0243810.ref001","article-title":"Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction","author":"S Vallabhajosyula","year":"2019","journal-title":"Catheter Cardiovasc 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