Association between Hospital Cardiac Catheter Laboratory Status, use of an Invasive Strategy and Outcomes after NSTEMI

Abstract

Background
While previous studies report increased use of invasive coronary strategy in patients admitted to hospitals with onsite cardiac catheter laboratory (CCL) facilities, the utility of invasive coronary strategy according to types of CCL facilities at the first admitting hospital and clinical outcomes is unknown.

Methods
We included 452,216 patients admitted with a diagnosis of NSTEMI in England & Wales between 2007-2015. The admitting hospitals were categorized into; no-laboratory, diagnostic and PCI hospitals according to CCL facilities. Multilevel logistic regression models were used to study association between CCL facilities and in-hospital outcomes.

Results
97,777 (21.6%) were admitted to `no laboratory` whereas 134,381 (29.7%) and 220,058 (48.7%) patients were admitted to `diagnostic` and PCI hospitals, respectively. Use of coronary angiography was significantly higher in PCI hospital (77.3%) compared to `diagnostic` (63.2%) and `no laboratory` (61.4%) hospitals. The adjusted odds of in-hospital mortality were similar for `diagnostic` (OR 0.93 95%CI 0.83-1.04) and PCI hospitals (OR 1.09 95%CI 0.96-1.24), compared to `no laboratory` hospitals. However, in high-risk NSTEMI (defined as GRACE score>140) subgroup, an admission to `diagnostic` hospitals was associated with significantly increased in-hospital mortality (OR 1.36 95%CI 1.06-1.75) compared to `no laboratory` and PCI hospitals.

Conclusions
Our study highlights important differences in both the utilisation of invasive coronary strategy and subsequent management/outcomes of NSTEMI patients according to admitting hospital CCL facilities. High-risk NSTEMI patients admitted to ‘diagnostic’ hospitals had greater in-hospital mortality, possibly because of reduced PCI use, which needs to be addressed.