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Invasive therapy in management of Unstable Angina (UA) and Non-ST-Elevation Myocardial Infarction (NSTEMI) is a matter of debate.
We analyzed discharge weighted Nationwide Inpatient Sample (NIS) from 2001 to 2010. Predictors of invasive management and mortality were analyzed using logistic regression with 95% confidence interval (CI).
Out of 4,586,447 patients 87.3% had NSTEMI and 12.7% had UA. Cardiac catheterization (Cath) rates increased from 44.8% in 2001 to 59.6% in 2010. In UA 6.4% patients had stress testing and 17.4% had Cath while in NSTEMI the numbers were 29.7% and 57.6% respectively with 98.4% of those stress tested undergoing Cath. Increasing age, female sex and chronic kidney disease were negative predictors while NSTEMI, cardiogenic shock and prior percutaneous coronary intervention (PCI) were positive predictors of invasive therapy. PCI rates increased from 18.9% to 30.7%. During the same period mortality decreased from 2.2% to 1.8% in the invasive group and from 11.6% to 7.8% in the conservative group. On adjusting for age, race and sex, NSTEMI was a positive predictor (OR 18.65, CI 17.62-19.74 p-Value<0.001) and Cath (OR 0.36, CI 0.35-0.36 p-Value<0.001) a negative predictor of mortality.
Our analysis shows an increasing trend in use of invasive therapy with decreasing mortality. Mortality in conservative group was much higher than the invasive group with Cath a negative predictor of mortality.
Oral Contributions West, Room 3004
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: ACS: Outcomes
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 913-4
- 2013 American College of Cardiology Foundation