Temporal trends in the use of invasive cardiac procedures for non-ST segment elevation acute coronary syndromes according to initial risk stratification.
Authors
Jedrzkiewicz, SeanGoodman, Shaun G.
Yan, Raymond T.
Welsh, Robert C.
Kornder, Jan
DeYoung, J. Paul
Wong, Graham C.
Rose, Barry
Grondin, Francois R.
Gallo, Richard
Huang, Wei
Gore, Joel M.
Yan, Andrew T.
Canadian Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators
Student Authors
Wei HuangUMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2009-11-01Keywords
Acute Coronary SyndromeAge Factors
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Canada
Cohort Studies
Coronary Angiography
Coronary Artery Bypass
Decision Making
Electrocardiography
Female
Heart Catheterization
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Revascularization
Odds Ratio
Practice Guidelines as Topic
Probability
Registries
Retrospective Studies
Risk Assessment
Risk Management
Severity of Illness Index
Sex Factors
Survival Analysis
Cardiovascular Diseases
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Current guidelines support an early invasive strategy in the management of high-risk non-ST elevation acute coronary syndromes (NSTE-ACS). Although studies in the 1990s suggested that highrisk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada. OBJECTIVE: To examine the in-hospital use of coronary angiography and revascularization in relation to risk among less selected patients with NSTE-ACS. METHODS: Data from the prospective, multicentre Global Registry of Acute Coronary Events (main GRACE and expanded GRACE2) were used. Between June 1999 and September 2007, 7131 patients from across Canada with a final diagnosis of NSTE-ACS were included the study. The study population was stratified into low-, intermediate- and high-risk groups, based on their calculated GRACE risk score (a validated predictor of in-hospital mortality) and according to time of enrollment. RESULTS: While rates of in-hospital death and reinfarction were significantly (P<0.001) greater in higher-risk patients, the in-hospital use of cardiac catheterization in low- (64.7%), intermediate- (60.3%) and highrisk (42.3%) patients showed an inverse relationship (P<0.001). This trend persisted despite the increase in the overall rates of cardiac catheterization over time (47.9% in 1999 to 2003 versus 51.6% in 2004 to 2005 versus 63.8% in 2006 to 2007; P<0.001). After adjusting for confounders, intermediate-risk (adjusted OR 0.80 [95% CI 0.70 to 0.92], P=0.002) and high-risk (adjusted OR 0.38 [95% CI 0.29 to 0.48], P<0.001) patients remained less likely to undergo in-hospital cardiac catheterization. CONCLUSION: Despite the temporal increase in the use of invasive cardiac procedures, they remain paradoxically targeted toward low-risk patients with NSTE-ACS in contemporary practice. This treatment-risk paradox needs to be further addressed to maximize the benefits of invasive therapies in Canada.Permanent Link to this Item
http://hdl.handle.net/20.500.14038/31204PubMed ID
19898699Related Resources
Link to article in PubMedRights
Citation: Can J Cardiol. 2009 Nov;25(11):e370-6.Collections
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