TY - JOUR
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
N1 - The authors gratefully acknowledge the contributions of all of the hospitals and health professionals who participate in the MINAP registry.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
AB - 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.
KW - Non-ST elevation acute myocardial infarction (NSTEMI)
KW - cardiac catheterization facilities
KW - coronary angiography
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85081008257&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2019.10.010
DO - 10.1016/j.cjca.2019.10.010
M3 - Article
C2 - 32146069
VL - 36
SP - 868
EP - 877
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
SN - 0828-282X
IS - 6
ER -