TCT paradox: Patients more likely to survive MI during interventional cardiology conference

Patients hospitalized with acute myocardial infarction (AMI) actually fare better when some of the top minds in interventional cardiology are away at the annual Transcatheter Cardiovascular Therapeutics (TCT) meeting, suggests a study published March 9 in the Journal of the American Heart Association.

The study’s release date is particularly timely considering another major conference—the American College of Cardiology’s Scientific Session—kicks off this weekend.

Researchers looked at data from 2007 through 2012 to analyze AMI outcomes for Medicare beneficiaries at major teaching hospitals during TCT dates as well as identical nonmeeting days in the surrounding 10 weeks. Adjusted 30-day mortality was 15.4 percent for patients admitted during meeting days versus 16.7 percent on other dates. The biggest gap occurred among patients with non-ST-segment-elevation MI (NSTEMI) who didn’t receive percutaneous coronary intervention (16.9 versus 19.5 percent).

The overall mortality difference was driven entirely by NSTEMI (13.9 versus 15.8 percent) while STEMI patients had a similar risk of death regardless of the date they were admitted.

“Many medical interventions deliver no mortality benefit, and the fact that mortality actually falls for heart attack patients during these conference dates raises important questions about how care might differ during these periods,” said lead author Anupam B. Jena, MD, PhD, an associate professor of health care policy at Harvard Medical School and physician at Massachusetts General Hospital.

However, no significant differences were detected for meeting versus nonmeeting dates in terms of how often an interventional cardiologist was involved in care or how often PCI was performed. These findings suggest something is different—and more beneficial—about the way patients are treated with medical management alone during TCT dates, the authors wrote.

“Identifying the precise changes in treatment through use of registry data may provide valuable insights into the causal effects of specific care patterns on acute myocardial infarction mortality,” Jena et al. wrote.

The analysis included 3,153 AMI hospitalizations during meeting dates and 31,156 on other dates. Jena and colleagues used claims data to identify which physicians likely attended TCT and which likely did not.

They said they chose TCT for the study because of its large proportion of interventional cardiologists—3,690 out of 4,483 physicians attending the conference in 2015 were interventional/invasive cardiologists, according to the authors.

“By focusing on AMI and analyzing outcomes of patients treated during dates of a meeting that is primarily attended by interventional cardiologists, we assumed that differences in patient outcomes between meeting and nonmeeting dates could be more directly linked to differences in interventional cardiologists practicing during the two periods,” they wrote.

Compared to physicians who treated patients in hospitals during TCT, attendees were of similar age and sex but averaged a greater number of academic publications (18.9 versus 6.3) and performed more PCIs annually (85.6 versus 63.3). But the study’s findings suggest the doctors who didn’t attend the meetings were equally proficient at stenting but better at nonprocedural care, Jena said. It’s just not clear yet what they do differently.

“Treating a cardiac patient isn't just about cardiac issues—it's about other factors that the patient brings to the hospital,” Jena said. “The types of doctors who attend these meetings seem to provide different care, at least for a subgroup of patients. This is an unfortunate paradox given that professional conferences are designed to actually makes us better physicians and improve the care we deliver.”