Carolina Malta Hansen1, Tracy Y Wang2, Anita Y Chen2, Karen Chiswell2, Deepak L Bhatt3, Jonathan R Enriquez4, Timothy Henry5, Matthew T Roe2. 1. Duke Clinical Research Institute, Durham, North Carolina. Electronic address: carolina.hansen@duke.edu. 2. Duke Clinical Research Institute, Durham, North Carolina. 3. Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. 4. University of Missouri-Kansas City, Kansas City, Missouri. 5. Cedars-Sinai Heart Institute, Los Angeles, California.
Abstract
OBJECTIVES: The study sought to characterize patient- and hospital-level variation in early angiography use among non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: Contemporary implementation of guideline recommendations for early angiography use in NSTEMI patients in the United States have not been described. METHODS: The study analyzed NSTEMI patients included in ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry (2012 to 2014) who underwent in-hospital angiography. Timing of angiography was categorized as early (≤24 h) vs. delayed (>24 h). The study evaluated factors associated with early angiography, hospital-level variation in early angiography use, and the relationship with quality-of-care measures. RESULTS: A total of 79,760 of 138,688 (57.5%) patients underwent early angiography. Factors most strongly associated with delayed angiography included weekend or holiday presentation, lower initial troponin ratio values, higher initial creatinine values, heart failure on presentation, and older age. Median hospital-level use of early angiography was 58.5% with wide variation across hospitals (21.7% to 100.0%). Patient characteristics did not differ substantially across hospitals grouped by tertiles of early angiography use (low, middle, and high). Hospitals in the highest tertile tended to more commonly use guideline-recommended medications and had higher defect-free care quality scores. CONCLUSIONS: In contemporary U.S. practice, high-risk clinical characteristics were associated with lower use of early angiography in NSTEMI patients; hospital-level use of early angiography varied widely despite few differences in case mix. Hospitals that most commonly utilized early angiography also had higher quality-of-care metrics, highlighting the need for improved NSTEMI guideline adherence.
OBJECTIVES: The study sought to characterize patient- and hospital-level variation in early angiography use among non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: Contemporary implementation of guideline recommendations for early angiography use in NSTEMI patients in the United States have not been described. METHODS: The study analyzed NSTEMI patients included in ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry (2012 to 2014) who underwent in-hospital angiography. Timing of angiography was categorized as early (≤24 h) vs. delayed (>24 h). The study evaluated factors associated with early angiography, hospital-level variation in early angiography use, and the relationship with quality-of-care measures. RESULTS: A total of 79,760 of 138,688 (57.5%) patients underwent early angiography. Factors most strongly associated with delayed angiography included weekend or holiday presentation, lower initial troponin ratio values, higher initial creatinine values, heart failure on presentation, and older age. Median hospital-level use of early angiography was 58.5% with wide variation across hospitals (21.7% to 100.0%). Patient characteristics did not differ substantially across hospitals grouped by tertiles of early angiography use (low, middle, and high). Hospitals in the highest tertile tended to more commonly use guideline-recommended medications and had higher defect-free care quality scores. CONCLUSIONS: In contemporary U.S. practice, high-risk clinical characteristics were associated with lower use of early angiography in NSTEMI patients; hospital-level use of early angiography varied widely despite few differences in case mix. Hospitals that most commonly utilized early angiography also had higher quality-of-care metrics, highlighting the need for improved NSTEMI guideline adherence.
Authors: Michael G Nanna; Eric D Peterson; Angie Wu; Tina Harding; Anthony N Galanos; Lisa Wruck; Karen P Alexander Journal: Am Heart J Date: 2019-10-23 Impact factor: 4.749
Authors: Luke P Dawson; David Chen; Misha Dagan; Jason Bloom; Andrew Taylor; Stephen J Duffy; James Shaw; Jeffrey Lefkovits; Dion Stub Journal: JAMA Netw Open Date: 2021-11-01
Authors: Thabo Mahendiran; David Nanchen; David Meier; Baris Gencer; Roland Klingenberg; Lorenz Räber; David Carballo; Christian M Matter; Thomas F Lüscher; Stephan Windecker; François Mach; Nicolas Rodondi; Olivier Muller; Stephane Fournier Journal: J Interv Cardiol Date: 2020-03-03 Impact factor: 2.279