Rashid, M, Fischman, DL, Martinez, SC, Capers, Q, Savage, M, Zaman, A, Curzen, N, Ensor, J, Potts, J, Mohamed, MO, Kwok, CS, Kinnaird, T, Bagur, R and Mamas, M (2019) Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA. Coronary Artery Disease, 30 (1). pp. 159-170. ISSN 1473-5830

[thumbnail of manuscript CAD.docx] Text
manuscript CAD.docx - Accepted Version

Download (96kB)
[thumbnail of Figures CAD.docx] Text
Figures CAD.docx - Supplemental Material

Download (89kB)


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.

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.

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.
Uncontrolled Keywords: coronary angiography, mortality, non-ST-elevation acute coronary syndrome, temporal trends, time
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: 22 Jan 2020 01:30
URI: https://eprints.keele.ac.uk/id/eprint/5742

Actions (login required)

View Item
View Item