5258Trends and outcomes of use of coronary angiography in management of non-ST-Elevation acute coronary syndromes (NSTEACS), a population based cohort study

Rashid, M; Potts, J; Kwok, C; Mohammed, M; Shoaib, A; Esnsor, J; Ayyaz-Ul-Haq, M; Nolan, J; Mamas, M

Abstract

Background: Non-ST-elevation acute coronary syndromes (NSTEACS) remains most vulnerable phenotype of acute myocardial infarction despite significant improvements in treatment and provision of guideline-recommended care. Coronary angiography (CA) is the mainstay of an invasive strategy in this cohort of patients. There is limited data on temporal trends in utilization of CA in real-world population-based settings.

Purpose: We sought to investigate temporal trends in utilization of coronary angiography, a difference in clinical characteristics of patients and receipt of coronary angiography, and predictor of coronary angiography. We also studied the associations between use of CA and in-hospital outcomes of death, major bleeding, cardiac and vascular complications.

Methods: We analyzed data from National Inpatient Sample (NIS) from 2004–2014. We identified all inpatient admissions age ≥18 with a primary diagnosis of NSTEACS during the study period. Descriptive statistics were employed in the weighted data to illustrate temporal trends in utilization of CA in patients stratified according to age, comorbidity burden, gender, and ethnicity. Multivariate logistic regression models were used to investigate predictors and association of CA with above-noted outcomes.

Results: From a total of 4,380,827 inpatient records with a diagnosis of NSTEACS, 57.5% received CA during the timeframe studied. Patients receiving CA were more likely to be male (61.7% vs 49.7%, p<0.001), younger (Median age 65 (IQR 46–75)) and less comorbid as defined per chalrson comorbidity index (CCI) (CCI=0 66.8% vs 33.2%, p<0.001). The proportions of patients receiving CA increased from 48.5% to 68.5%, and similar increasing trends were observed across different groups stratified according to age, gender, ethnicity and comorbidity burden. Non-cardiac comorbidities such as dementia (OR 0.32 95% CI 0.31–0.33), renal failure (OR 0.66 95% CI 0.65–0.67), metastatic cancer (OR 0.33 95% CI 0.31–0.35) and liver disease (OR 0.76 95% CI 0.72–0.80) had strong inverse relationship with receipt of CA. Finally, utilization of CA was strongly associated with decreased odds of in-hospital mortality (OR 0.38 95% CI 0.36–0.40).

Conclusion: In this one of the largest population-based study of over 4.3 million inpatient admissions, we observed a temporal increase in utilization of CA. There was significant heterogeneity in receipt of CA across different group wherein older, females and more comorbid were less likely to receive CA.

• Journal Article Type: Article
• Online Publication Date: Aug 28, 2018
• Publication Date: Aug 1, 2018
• Deposit Date: Jun 28, 2023
• Journal: European Heart Journal
• Print ISSN: 0195-668X
• Electronic ISSN: 1522-9645
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: suppl_1
• DOI: https://doi.org/10.1093/eurheartj/ehy566.5258
• Keywords: Cardiology and Cardiovascular Medicine; acute coronary syndromes; coronary angiography; non-st-segment acute coronary syndromes