TY  - BOOK
AU  - Case, Brian C
AU  - Dolman, Sarahfaye
AU  - Forrestal, Brian J
AU  - Waksman, Ron
AU  - Wang, Yanying
AU  - Weintraub, William S
AU  - Yerasi, Charan
TI  - Admissions Rate and Timing of Revascularization in the United States in Patients With Non-ST-Elevation Myocardial Infarction
SN  - 0002-9149
PY  - 2020///
KW  - *Coronary Artery Bypass/sn [Statistics & Numerical Data]
KW  - *Hospital Mortality
KW  - *Non-ST Elevated Myocardial Infarction/su [Surgery]
KW  - *Percutaneous Coronary Intervention/sn [Statistics & Numerical Data]
KW  - *Time-to-Treatment/sn [Statistics & Numerical Data]
KW  - Aged
KW  - Aged, 80 and over
KW  - Anemia/ep [Epidemiology]
KW  - Arrhythmias, Cardiac/ep [Epidemiology]
KW  - Blood Coagulation Disorders/ep [Epidemiology]
KW  - Comorbidity
KW  - Coronary Angiography
KW  - Diabetes Mellitus/ep [Epidemiology]
KW  - Early Medical Intervention
KW  - Female
KW  - Hospitalization
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Mortality
KW  - Myocardial Revascularization/sn [Statistics & Numerical Data]
KW  - Non-ST Elevated Myocardial Infarction/ep [Epidemiology]
KW  - United States/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - Clinical trials have shown improved outcomes with an early invasive approach for non-ST-elevation myocardial infarction (NSTEMI). However, real-world data on clinical characteristics and outcomes based on time to revascularization are lacking. We aimed to analyze NSTEMI rates, revascularization timing, and mortality using the 2016 Nationwide Readmissions Database. We identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic angiography, with 34.1% (255,199) revascularized. Of revascularized patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission (32.9%; 65,155). This differs from CABG, which was most commonly performed on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate increased after day 1 for PCI patients and after day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed. Our study shows that patients undergoing early revascularization differ from those undergoing later revascularization. Mortality is generally high with delayed revascularization, as these are sicker patients. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients. Copyright (c) 2020 Elsevier Inc. All rights reserved
UR  - https://dx.doi.org/10.1016/j.amjcard.2020.08.010
UR  - https://dx.doi.org/10.1016/j.amjcard.2020.08.010
ER  -