Baseline risk, timing of invasive strategy and guideline compliance in NSTEMI: Nationwide analysis from MINAP

Muhammad Rashid*, Nick Curzen, Tim Kinnaird, Claire A. Lawson, Phyo K. Myint, Evangelos Kontopantelis, Mohamed O. Mohamed, Ahmad Shoaib, Chris P. Gale, Adam Timmis, Mamas A Mamas

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background International guidelines recommend that for NSTEMI, the timing of invasive strategy (IS) is a function of patient's baseline risk. The extent to which this is delivered across and within healthcare systems is unknown.MethodsData were derived from 137,265 patients admitted with an NSTEMI diagnosis between 2010 and 2015 in England and Wales. Patients were stratified into low, intermediate and high-risk in keeping with international guidelines. Time to IS was categorised into early (24 h), intermediate (25–72 h) and late (>72 h). Multivariable logistic regression models were used to identify independent predictors of guidelines recommended receipt of IS.ResultsThere were 3608 (2.6%) low, 5037 (3.7%) intermediate and 128,621 (93.7%) high-risk patients. Guidelines recommended use of IS was significantly lower in high-risk (16.4%) compared to intermediate (64.7%) and low-risk (62.5%) groups. Both men and women in the low-risk category were almost twice as likely to receive early IS compared to high-risk men (28.9% vs 17%, p < 0.001) and women (26.9% vs 15%, p < 0.001). Women (OR 0.91 95%CI 0.88–0.94), troponin elevation (OR 0.39 95%CI 0.36–0.43) and acute heart failure on admission (OR 0.65 95%CI 0.61–0.70) were strong negative predictors of receiving IS within recommended time in the high-risk group.ConclusionOur study shows that IS for management of NSTEMI is not delivered according to international guidelines recommendations. Specifically, the disconnect between baseline risk and utility of IS increases with increasing risk and women achieve slower access than men to IS.
Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalInternational Journal of Cardiology
Volume301
Early online date28 Nov 2019
DOIs
Publication statusPublished - 15 Feb 2020

Keywords

  • Guidelines indicated care
  • Invasive strategy
  • Non-ST elevation acute myocardial infarction
  • Risk stratification
  • Timing
  • MANAGEMENT
  • METAANALYSIS
  • ACUTE CORONARY SYNDROMES
  • UNSTABLE ANGINA
  • OUTCOMES
  • ASSOCIATION
  • INTERVENTION
  • ELEVATION MYOCARDIAL-INFARCTION

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    Rashid, M., Curzen, N., Kinnaird, T., Lawson, C. A., Myint, P. K., Kontopantelis, E., Mohamed, M. O., Shoaib, A., Gale, C. P., Timmis, A., & Mamas, M. A. (2020). Baseline risk, timing of invasive strategy and guideline compliance in NSTEMI: Nationwide analysis from MINAP. International Journal of Cardiology, 301, 7-13. https://doi.org/10.1016/j.ijcard.2019.11.146