Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA

Rashid, Muhammad, Fischman, David L., Martinez, Sara C., Capers, Quinn, Savage, Michael, Zaman, Azfar, Curzen, Nick, Ensor, Joie, Potts, Jessica, Mohamed, Mohamed O., Kwok, Chun Shing, Kinnaird, Tim, Bagur, Rodrigo and Mamas, Mamas (2019) Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA. Coronary Artery Disease, 30 (3), 159-170. (doi:10.1097/MCA.0000000000000693).

Abstract

OBJECTIVE: This study aims to investigate the temporal trends in utilization of invasive coronary angiography (CA) at different time points and changing profiles of patients undergoing CA following non-ST-elevation acute coronary syndrome (NSTEACS). We also describe the association between time to CA and in-hospital clinical outcomes.

PATIENTS AND METHODS: We queried the National Inpatient Sample to identify all admissions with a primary diagnosis of NSTEACS from 2004 to 2014. Patients were stratified into early (day 0, 1), intermediate (day 2) and late strategy (day≥3) according to time to CA. Multivariable logistic regression was used to investigate the association between time to CA and in-hospital mortality, major bleeding, stroke and Major Adverse Cardiac and Cerebrovascular Events.

RESULTS: A total of 4 380 827 records were identified with a diagnosis of NSTEACS, out of which 57.5% received CA. The proportion of patients undergoing early CA increased from 65.6 to 72.6%, whereas late CA commensurately declined from 19.6 to 13.5%. Patients receiving early CA were younger (age: 64 vs. 70 years), more likely to be male (63.7 vs. 55.3%) and of Caucasian ethnic background (68.7 vs. 64.7%) compared with late CA group. Similarly, Women, weekend admissions and African Americans remain less likely to receive early CA. In-hospital mortality was lowest in the intermediate group (odds ratio=0.30, 95% confidence interval: 0.28-0.33).

CONCLUSION: Use of early CA has increased in the management of NSTEACS; however, there remain significant disparities in utilization of an early invasive approach in women, African Americans, admission day and older patients in the USA.

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Contributors

Author: Nick Curzen

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