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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Author
Rashid, MuhammadFischman, 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
Affiliation
Univ Arizona, Div CardiolIssue Date
2019-01-18
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NATURE PUBLISHING GROUPCitation
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 REPORTSRights
© 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
2045-2322PubMed ID
30659213Version
Final published versionAdditional Links
https://www.nature.com/articles/s41598-018-36504-yae974a485f413a2113503eed53cd6c53
10.1038/s41598-018-36504-y
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