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    Temporal trends and inequalities in coronary angiography utilization in the management of non-ST-Elevation acute coronary syndromes in the US

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    s41598-018-36504-y.pdf
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    Author
    Rashid, Muhammad
    Fischman, David L
    Gulati, Martha
    Tamman, Khalid
    Potts, Jessica
    Kwok, Chun Shing
    Ensor, Joie
    Shoaib, Ahmad
    Mansour, Hossam
    Zaman, Azfar
    Savage, Michael P
    Mamas, Mamas A
    Show allShow less
    Affiliation
    Univ Arizona, Div Cardiol
    Issue Date
    2019-01-18
    
    Metadata
    Show full item record
    Publisher
    NATURE PUBLISHING GROUP
    Citation
    Rashid, M., Fischman, D. L., Gulati, M., Tamman, K., Potts, J., Kwok, C. S., ... & Savage, M. P. (2019). Temporal trends and inequalities in coronary angiography utilization in the management of non-ST-Elevation acute coronary syndromes in the US. Scientific reports, 9(1), 240.
    Journal
    SCIENTIFIC REPORTS
    Rights
    © The Author(s) 2019. This article is licensed under a Creative Commons Attribution 4.0 International License.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Coronary angiography (CA) is the basis of an invasive management strategy in non-ST elevation acute coronary syndromes (NSTEACS). There are limited contemporary data on national temporal trends in utilization of CA in different patient subgroups. We sought to investigate temporal trends, predictors and clinical outcomes associated with the use of CA in the US. Using the Nationwide Inpatient Sample (NIS) from 2004-2014, we identified all inpatient admissions, age ≥18, with a primary diagnosis of NSTEACS. Descriptive statistics and multivariable logistic regression models were used to investigate temporal trends, predictors and clinical outcomes associated with CA. From a total of 4,380,827 patients, 57.5% received CA during the study period and were more likely to be male, younger and less comorbid as defined per Charlson comorbidity index. The proportion of patients receiving CA increased from 48.5% to 68.5%, however, higher proportional increase was observed in males (53.9% to 69.4% Ptrend < 0.001) and those age ≤60 years (59.0% to 77.9% Ptrend < 0.001). Prior history of CABG (OR 0.33 95%CI 0.35-0.36), previous PCI (OR 0.84 95%CI 0.83-0.86) and previous AMI (OR 0.65 95%CI 0.64-0.67) were inversely related with receipt of CA. Receipt of CA was strongly associated with decreased odds of in-hospital mortality (OR 0.38 95%CI 0.36-0.40). In this national analysis, we observed a temporal increase in utilization of CA albeit slower adoption was noted in older, women and more comorbid patients. The risk-treatment paradox wherein patients who are most likely to benefit were less likely to receive CA persists even in contemporary practice.
    Note
    Open access journal.
    ISSN
    2045-2322
    PubMed ID
    30659213
    DOI
    10.1038/s41598-018-36504-y
    Version
    Final published version
    Additional Links
    https://www.nature.com/articles/s41598-018-36504-y
    ae974a485f413a2113503eed53cd6c53
    10.1038/s41598-018-36504-y
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