DL Fischman
Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA
Fischman, DL; Martinez, SC; Potts, J; Mohamed, MO; Kwok, CS; Capers, Q; Savage, M; Zaman, A; Curzen, N; Ensor, J; Rashid, M; Kinnaird, T; Bagur, R; Mamas, M
Authors
SC Martinez
Jessica Potts j.e.potts@keele.ac.uk
MO Mohamed
CS Kwok
Q Capers
M Savage
A Zaman
N Curzen
J Ensor
Muhammad Rashid m.rashid@keele.ac.uk
T Kinnaird
R Bagur
Mamas Mamas m.mamas@keele.ac.uk
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.
Acceptance Date | Jan 22, 2019 |
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Publication Date | May 1, 2019 |
Journal | Coronary Artery Disease |
Print ISSN | 0954-6928 |
Publisher | Lippincott, Williams & Wilkins |
Pages | 159-170 |
DOI | https://doi.org/10.1097/MCA.0000000000000693 |
Keywords | coronary angiography, mortality, non-ST-elevation acute coronary syndrome, temporal trends, time |
Publisher URL | http://doi.org/10.1097/MCA.0000000000000693 |
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