Date of Award

Spring 4-8-2026

Embargo Period

4-26-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Kit Simpson

Second Advisor

David Fitzgerald

Third Advisor

La'Shanda Wood

Abstract

Cardiovascular disease (CVD) remains one of the leading causes of death in the United States. Coronary artery disease (CAD) is the largest contributor to deaths that result from cardiovascular disease. When CAD is left untreated, it can result in an acute ST elevation myocardial infarction (STEMI). To treat coronary blockages caused by CAD, a percutaneous coronary intervention (PCI) is performed. A PCI is a non-invasive procedure that uses coronary balloons and stents to open a narrowed or blocked coronary artery and restore blood flow.

An acute ST elevation myocardial infarction (STEMI) is a major cause of early hospital readmissions. Technological advancements have improved clinical outcomes in PCI procedures. In recent years, advancements such as intravascular ultrasound (IVUS) have improved stent optimization, arterial imaging, and stent deployment. Despite these innovations, readmissions within 30 days remain a challenge for healthcare organizations. Existing studies have shown that IVUS significantly affects long-term outcomes; there is limited evidence of its impact on short-term outcomes, such as 30-day admissions. The purpose of this study is to examine the role of IVUS in 30-day readmissions among Medicare patients diagnosed with an acute ST-elevation myocardial infarction.

This study used a quantitative, retrospective observational approach to examine the impact of IVUS-guided PCI on 30-day readmissions in Medicare patients versus angiography-guided PCI. The study population was derived from the Medicare 5% LDS. Using ICD-10 and CPT codes, patients were identified with an acute ST elevation myocardial infarction diagnosis. A multivariable logistic regression analysis was used to compare IVUS-guided PCI with angiography-guided PCI and to assess the association with 30-day readmission, controlling for demographics.

The findings of the study suggest that procedural innovations and advancements, such as IVUS, affect procedural outcomes but are not statistically significantly associated with 30-day readmissions. The findings suggest that other variables, such as comorbidities and socioeconomic barriers, are statistically significantly associated with 30-day readmissions. These results highlight the importance of addressing health disparities among high-risk populations, tailoring healthcare to the individual patient, and implementing practices that prioritize post-discharge care.

Rights

Copyright is held by the author. All rights reserved.

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