Rashid, M, Fischman, DL, Martinez, SC, Capers, Q, Savage, M, Zaman, A, Curzen, N, Ensor, J ORCID: 0000-0001-7481-0282, Potts, J, Mohamed, MO, Kwok, CS ORCID: 0000-0001-7047-1586, Kinnaird, T, Bagur, R ORCID: 0000-0003-1888-9429 and Mamas, M ORCID: 0000-0001-9241-8890 (2019) Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA. Coronary Artery Disease. ISSN 1473-5830

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Abstract

OBJECTIVE: This study aims to investigate the temporal trends in utilization of invasive coronary angiography (CA) at different time points and changing profiles of patients undergoing CA following non-ST-elevation acute coronary syndrome (NSTEACS). We also describe the association between timing of CA and in-hospital clinical outcomes.

PATIENTS AND METHODS: We queried the National Inpatient Sample to identify all admissions with a primary diagnosis of NSTEACS from 2004 to 2014. Patients were stratified into early (day 0, 1), intermediate (day 2) and late strategy (day≥3) according to timing of CA. Multivariable logistic regression was used to investigate the association between timing of CA and in-hospital mortality, major bleeding, stroke and Major Adverse Cardiac and Cerebrovascular Events. RESULTS: A total of 4 380 827 records were identified with a diagnosis of NSTEACS, out of which 57.5% received CA. The proportion of patients undergoing early CA increased from 65.6 to 72.6%, whereas late CA commensurately declined from 19.6 to 13.5%. Patients receiving early CA were younger (age: 64 vs. 70 years), more likely to be male (63.7 vs. 55.3%) and of Caucasian ethnic background (68.7 vs. 64.7%) compared with late CA group. Similarly, Women, weekend admissions and African Americans remain less likely to receive early CA. In-hospital mortality was lowest in the intermediate group (odds ratio=0.30, 95% confidence interval: 0.28-0.33).

CONCLUSION: Use of early CA has increased in the management of NSTEACS; however, there remain significant disparities in utilization of an early invasive approach in women, African Americans, admission day and older patients in the USA.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Lippincott, Williams & Wilkins at http://doi.org/10.1097/MCA.0000000000000693 - please refer to any applicable terms of use of the publisher.
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 01 Feb 2019 14:25
Last Modified: 01 Feb 2019 14:33
URI: http://eprints.keele.ac.uk/id/eprint/5742

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