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

Muhammad Rashid* (Corresponding Author), Evangelos Kontopantelis, Tim Kinnaird, Nick Curzen, Chris P. Gale, Mohamed O. Mohamed, Ahmad Shoaib, Phyo Kyaw Myint, James Nolan, M. Justin Zaman, Adam Timmis, Mamas A. Mamas

*Corresponding author for this work

Research output: Contribution to journalArticle

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.
Original languageEnglish
JournalCanadian Journal of Cardiology
Early online date16 Oct 2019
DOIs
Publication statusE-pub ahead of print - 16 Oct 2019

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Cardiac Catheters
Hospital Laboratories
Hospital Mortality
Non-ST Elevated Myocardial Infarction
Logistic Models
Wales
Coronary Angiography
England

Keywords

  • Non-ST elevation acute myocardial infarction (NSTEMI)
  • cardiac catheterization facilities
  • coronary angiography
  • percutaneous coronary intervention

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Association between Hospital Cardiac Catheter Laboratory Status, use of an Invasive Strategy and Outcomes after NSTEMI. / Rashid, Muhammad (Corresponding Author); Kontopantelis, Evangelos; Kinnaird, Tim; Curzen, Nick; Gale, Chris P.; Mohamed, Mohamed O.; Shoaib, Ahmad; Myint, Phyo Kyaw; Nolan, James; Zaman, M. Justin ; Timmis, Adam; Mamas, Mamas A.

In: Canadian Journal of Cardiology, 16.10.2019.

Research output: Contribution to journalArticle

Rashid, M, Kontopantelis, E, Kinnaird, T, Curzen, N, Gale, CP, Mohamed, MO, Shoaib, A, Myint, PK, Nolan, J, Zaman, MJ, Timmis, A & Mamas, MA 2019, 'Association between Hospital Cardiac Catheter Laboratory Status, use of an Invasive Strategy and Outcomes after NSTEMI', Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2019.10.010
Rashid, Muhammad ; Kontopantelis, Evangelos ; Kinnaird, Tim ; Curzen, Nick ; Gale, Chris P. ; Mohamed, Mohamed O. ; Shoaib, Ahmad ; Myint, Phyo Kyaw ; Nolan, James ; Zaman, M. Justin ; Timmis, Adam ; Mamas, Mamas A. / Association between Hospital Cardiac Catheter Laboratory Status, use of an Invasive Strategy and Outcomes after NSTEMI. In: Canadian Journal of Cardiology. 2019.
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title = "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.",
keywords = "Non-ST elevation acute myocardial infarction (NSTEMI), cardiac catheterization facilities, coronary angiography, percutaneous coronary intervention",
author = "Muhammad Rashid and Evangelos Kontopantelis and Tim Kinnaird and Nick Curzen and Gale, {Chris P.} and Mohamed, {Mohamed O.} and Ahmad Shoaib and Myint, {Phyo Kyaw} and James Nolan and Zaman, {M. Justin} and Adam Timmis and Mamas, {Mamas A.}",
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T1 - Association between Hospital Cardiac Catheter Laboratory Status, use of an Invasive Strategy and Outcomes after NSTEMI

AU - Rashid, Muhammad

AU - Kontopantelis, Evangelos

AU - Kinnaird, Tim

AU - Curzen, Nick

AU - Gale, Chris P.

AU - Mohamed, Mohamed O.

AU - Shoaib, Ahmad

AU - Myint, Phyo Kyaw

AU - Nolan, James

AU - Zaman, M. Justin

AU - Timmis, Adam

AU - Mamas, Mamas A.

PY - 2019/10/16

Y1 - 2019/10/16

N2 - 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.

AB - 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.

KW - Non-ST elevation acute myocardial infarction (NSTEMI)

KW - cardiac catheterization facilities

KW - coronary angiography

KW - percutaneous coronary intervention

U2 - 10.1016/j.cjca.2019.10.010

DO - 10.1016/j.cjca.2019.10.010

M3 - Article

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

SN - 0828-282X

ER -