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Treatment of non-ST-Elevation Myocardial Infarction (NSTEMI) includes an initial invasive strategy (angiography followed by revascularization if appropriate) and an initial conservative strategy. The meta-analysis comparing the two pathways shows the benefit of invasive strategy over conservative strategy. Our objective is to compare patient characteristics and outcomes for invasive versus conservative strategy and to identify commonly documented reasons for undergoing conservative strategy.
We performed a retrospective-cohort-study of NSTEMI patients in a tertiary medical center in Asia using the cardiac catheterization database, electronic medical records, and case notes review.
Angiography was performed in 70.8% of NSTEMI patients. An invasive strategy was significantly associated with younger age, male gender, no past medical history of angiography, hypertension, diabetes mellitus, hyperlipidemia, acute myocardial infarction (AMI), chronic kidney disease, heart failure (HF), acute renal failure (ARF), cerebrovascular accident (CVA) and arrhythmia. After multivariate analysis, younger age (AOR=0.94, 95% CI 0.93-0.95), Malay ethnicity (AOR=0.49, 95% CI 0.33-0.73), past medical history of AMI (AOR=0.65, 95% CI 0.45-0.92), HF (AOR=0.50, 95% CI 0.35-0.72) and ARF (AOR=0.66, 95% CI 0.44-0.99) remained as independent predictors of invasive strategy. The invasive strategy was significantly associated with lower adverse in-hospital events such as in-patient death, HF, ARF, CVA and shorter length of stay with p-values of p<0.001, p=0.003 and p=0.001 respectively. The medical related reason was the top documented reasons for conservative strategy. Those who had a conservative strategy and was not offered angiography was significantly associated with a documented medical related reason. Whereas those who had conservative management and was offered angiography was significantly associated with a documented social or financial reason.
Angiography was associated with lower adverse in-hospital events. There is a prominent physician influence in those who undergo conservative strategy as suggested by medical related reason's (top documented reason) significant association with having not been offered angiography.