Author + information
- Ralf E. Harskamp,
- Tracy Wang,
- Deepak Bhatt,
- Stephen Wiviott,
- Ezra Amsterdam,
- Shuang Li,
- Laine Thomas,
- Robbert de Winter and
- Matthew Roe
Patients with NSTEMI and multi-vessel disease (MVD) identified during coronary angiography face a high-risk of mortality when treated with a medical management strategy (MMS) compared with revascularization.
We evaluated the use of MMS for 42,535 NSTEMI patients with 3-vessel disease (3-VD) or left main disease (LMD) during angiography at 423 hospitals participating in the ACTION Registry-GWTG from 2007-2012. Patients with prior CABG surgery were excluded, as revascularization options are limited. A total of 316 hospitals (n=41,310 pts) with an adequate volume of patients (≥25 pts) were stratified into tertiles by the use of MMS. Differences in characteristics and outcomes were analyzed across tertiles.
The yearly percentage of patients with 3-VD/LMD treated with MMS was 17%-19% (p-value=0.08), and the hospital-level percentage varied widely (median 17.1%, range: 0.0%-44.8%, p<0.0001). Patient characteristics, predicted mortality risk, inhospital mortality rates, and discharge treatments were similar across tertiles (Table). Hospitals in the lowest tertile had the greatest use of both PCI and CABG for patients with MVD.
Approximately 20% of patients with NSTEMI and 3-VD/LMD are treated with MMS without revascularization. Since the use of this strategy varies widely across U.S. hospitals despite relatively similar hospital-level case mix, these findings suggest that for these patients, there is no standard threshold for revascularization.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Appropriateness and Gaps in Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1116-113
- 2013 American College of Cardiology Foundation