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 Mamas

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background: Increased use of invasive coronary strategies in patients admitted to hospitals with on-site cardiac catheter laboratory (CCL) facilities has been reported, but the utilisation of invasive coronary strategies 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 non–ST-segment-elevation myocardial infarction (NSTEMI) in England and Wales from 2007 to 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 associations between CCL facilities and in-hospital outcomes.

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

Conclusions: This study highlights important differences in both the utilisation of invasive coronary strategies and subsequent management and 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
Pages (from-to)868-877
Number of pages10
JournalCanadian Journal of Cardiology
Volume36
Issue number6
Early online date16 Oct 2019
DOIs
Publication statusPublished - 1 Jun 2020

Keywords

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

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    Rashid, M., Kontopantelis, E., Kinnaird, T., Curzen, N., Gale, C. P., Mohamed, M. O., Shoaib, A., Myint, P. K., Nolan, J., Zaman, M. J., Timmis, A., & Mamas, M. (2020). Association Between Hospital Cardiac Catheter Laboratory Status, Use of an Invasive Strategy, and Outcomes After NSTEMI. Canadian Journal of Cardiology, 36(6), 868-877. https://doi.org/10.1016/j.cjca.2019.10.010