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Association between hospital cardiac catheter laboratory status, use of an invasive strategy, and outcomes after NSTEMI

Association between hospital cardiac catheter laboratory status, use of an invasive strategy, and outcomes after NSTEMI
Association between hospital cardiac catheter laboratory status, use of an invasive strategy, and outcomes after NSTEMI

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.

1861-0684
868-877
Rashid, Muhammad
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Kontopantelis, Evangelos
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Kinnaird, Tim
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Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Gale, Chris P.
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Mohamed, Mohamed O.
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Shoaib, Ahmad
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Kwok, Chun Shing
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Myint, Phyo Kyaw
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Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Zaman, M Justin
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Timmis, Adam
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Mamas, Mamas
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Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Gale, Chris P.
96b5706c-fd86-4b41-9568-3d917ef2c805
Mohamed, Mohamed O.
c9566561-5ab5-4d7b-b05d-079ebde7a279
Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Myint, Phyo Kyaw
7c4ec0bf-859f-4c3d-83fa-149ddf5c8283
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Zaman, M Justin
a5be5a1d-a193-4ca2-8421-64e47985a424
Timmis, Adam
afa86b24-5997-4e05-a891-ccaa20c90f20
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af

Rashid, Muhammad, Kontopantelis, Evangelos, Kinnaird, Tim, Curzen, Nick, Gale, Chris P., Mohamed, Mohamed O., Shoaib, Ahmad, Kwok, Chun Shing, Myint, Phyo Kyaw, Nolan, James, Zaman, M Justin, Timmis, Adam and Mamas, Mamas (2020) Association between hospital cardiac catheter laboratory status, use of an invasive strategy, and outcomes after NSTEMI. Clinical Research in Cardiology, 36 (6), 868-877. (doi:10.1016/j.cjca.2019.10.010).

Record type: Article

Abstract

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.

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More information

Accepted/In Press date: 3 October 2019
e-pub ahead of print date: 16 October 2019
Published date: June 2020

Identifiers

Local EPrints ID: 443339
URI: http://eprints.soton.ac.uk/id/eprint/443339
ISSN: 1861-0684
PURE UUID: 551974ef-1abf-44e5-85e8-813bb0e1e1d4
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 20 Aug 2020 16:36
Last modified: 17 Mar 2024 03:02

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Contributors

Author: Muhammad Rashid
Author: Evangelos Kontopantelis
Author: Tim Kinnaird
Author: Nick Curzen ORCID iD
Author: Chris P. Gale
Author: Mohamed O. Mohamed
Author: Ahmad Shoaib
Author: Chun Shing Kwok
Author: Phyo Kyaw Myint
Author: James Nolan
Author: M Justin Zaman
Author: Adam Timmis
Author: Mamas Mamas

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