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Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA

Rashid, Muhammada,b; Fischman, David L.f; Martinez, Sara C.g; Capers, Quinn IVh; Savage, Michaelf; Zaman, Azfarc; Curzen, Nickd; Ensor, Joiea; Potts, Jessicaa; Mohamed, Mohamed O.a,b; Kwok, Chun Shinga,b; Kinnaird, Time; Bagur, Rodrigoa,i; Mamas, Mamasa,b

doi: 10.1097/MCA.0000000000000693
Acute Myocardial Infarction

Objective This study aims to investigate the temporal trends in utilization of invasive coronary angiography (CA) at different time points and changing profiles of patients undergoing CA following non-ST-elevation acute coronary syndrome (NSTEACS). We also describe the association between time to CA and in-hospital clinical outcomes.

Patients and methods We queried the National Inpatient Sample to identify all admissions with a primary diagnosis of NSTEACS from 2004 to 2014. Patients were stratified into early (day 0, 1), intermediate (day 2) and late strategy (day≥3) according to time to CA. Multivariable logistic regression was used to investigate the association between time to CA and in-hospital mortality, major bleeding, stroke and Major Adverse Cardiac and Cerebrovascular Events.

Results A total of 4 380 827 records were identified with a diagnosis of NSTEACS, out of which 57.5% received CA. The proportion of patients undergoing early CA increased from 65.6 to 72.6%, whereas late CA commensurately declined from 19.6 to 13.5%. Patients receiving early CA were younger (age: 64 vs. 70 years), more likely to be male (63.7 vs. 55.3%) and of Caucasian ethnic background (68.7 vs. 64.7%) compared with late CA group. Similarly, Women, weekend admissions and African Americans remain less likely to receive early CA. In-hospital mortality was lowest in the intermediate group (odds ratio=0.30, 95% confidence interval: 0.28–0.33).

Conclusion Use of early CA has increased in the management of NSTEACS; however, there remain significant disparities in utilization of an early invasive approach in women, African Americans, admission day and older patients in the USA.

aKeele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University

bDepartment of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent

cDepartment of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne

dCoronary Research Group, Department of Cardiology, University Hospital Southampton & Faculty of Medicine, University of Southampton

eDepartment of Cardiology, University Hospital of Wales, Cardiff, UK

fDepartment of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

gDepartment of Cardiology, Providence St Peter Hospital, Olympia, WA

hDepartment of Cardiology, The Ohio State University School of Medicine, Columbus, Ohio, USA

iDepartment of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada

Correspondence to Muhammad Rashid, MBBS, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent ST5 5BG, UK Tel: +44 161 276 8666; fax: +44 178 267 4467; e-mail:

Received September 27, 2018

Received in revised form November 29, 2018

Accepted December 8, 2018

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