The University of Southampton
University of Southampton Institutional Repository

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

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

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.

0954-6928
159-170
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Fischman, David L.
af77a502-767d-486b-8a31-1c901ed57e0d
Martinez, Sara C.
681b32da-2de5-4553-ba25-10ab0c1e03b4
Capers, Quinn
33c99e8f-bedf-4451-bc16-da60103656b3
Savage, Michael
a70514d1-6c9b-4de4-a2ce-80c182b8cc85
Zaman, Azfar
1eb39d94-fdb9-466b-ab6c-7613255baf80
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ensor, Joie
ef369fc7-8408-4021-8661-f20b0259f8af
Potts, Jessica
50e7dd50-d7f6-44a3-8b7d-c1cb5ae8fe7d
Mohamed, Mohamed O.
c9566561-5ab5-4d7b-b05d-079ebde7a279
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Bagur, Rodrigo
4afad05d-aab4-48c7-ab89-fa9802123c59
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Fischman, David L.
af77a502-767d-486b-8a31-1c901ed57e0d
Martinez, Sara C.
681b32da-2de5-4553-ba25-10ab0c1e03b4
Capers, Quinn
33c99e8f-bedf-4451-bc16-da60103656b3
Savage, Michael
a70514d1-6c9b-4de4-a2ce-80c182b8cc85
Zaman, Azfar
1eb39d94-fdb9-466b-ab6c-7613255baf80
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ensor, Joie
ef369fc7-8408-4021-8661-f20b0259f8af
Potts, Jessica
50e7dd50-d7f6-44a3-8b7d-c1cb5ae8fe7d
Mohamed, Mohamed O.
c9566561-5ab5-4d7b-b05d-079ebde7a279
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Bagur, Rodrigo
4afad05d-aab4-48c7-ab89-fa9802123c59
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af

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).

Record type: Article

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.

Full text not available from this repository.

More information

Published date: 1 May 2019

Identifiers

Local EPrints ID: 433943
URI: http://eprints.soton.ac.uk/id/eprint/433943
ISSN: 0954-6928
PURE UUID: 12990fd4-1b5b-4293-ad29-33509182eb37
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 06 Sep 2019 16:30
Last modified: 18 Feb 2021 17:04

Export record

Altmetrics

Contributors

Author: Muhammad Rashid
Author: David L. Fischman
Author: Sara C. Martinez
Author: Quinn Capers
Author: Michael Savage
Author: Azfar Zaman
Author: Nick Curzen ORCID iD
Author: Joie Ensor
Author: Jessica Potts
Author: Mohamed O. Mohamed
Author: Chun Shing Kwok
Author: Tim Kinnaird
Author: Rodrigo Bagur
Author: Mamas Mamas

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×