The association between hospital teaching status and in-hospital outcomes among patients with type 2 myocardial infarction in the United States

ABSTRACT

Background: Type 2 myocardial infarction (T2MI) is characterized by an imbalance between myocardial oxygen supply and demand in the absence of acute coronary obstruction. The current lack of clear diagnostic and management guidelines for T2MI could lead to disparities in management and outcomes across different hospital settings.

Methods: We performed a retrospective analysis using the National Inpatient Sample from 2017 to 2022, identifying adult hospitalizations with T2MI. Hospitals were categorized as rural, urban non-teaching, or urban teaching. The primary outcome was in-hospital mortality. Survey-weighted logistic regression was used to identify predictors of mortality.

Results: Among all hospitalizations for T2MI, 8.3% occurred in rural hospitals, 16.3% in urban non-teaching hospitals, and 75.4% in urban teaching hospitals. Patients at urban teaching hospitals were slightly younger but had higher rates of comorbidities. In-hospital mortality was significantly greater in urban teaching hospitals (10.5% vs. 9.3% and 8.8% in urban non-teaching and rural hospitals, respectively). After adjustment, urban teaching hospital status remained an independent predictor of mortality.

Conclusion: Patients with T2MI treated at urban teaching hospitals were associated with increased mortality, length of stay, and total hospital charges. Teaching hospital status was also found to be an independent risk factor for in-hospital mortality.

Keywords: Myocardial infarction; type 2 myocardial infarction; mortality; teaching hospital