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Variation in treatment strategy for non-ST segment elevation myocardial infarction: A multilevel methodological approach.
- Source :
-
International journal of cardiology [Int J Cardiol] 2021 Apr 01; Vol. 328, pp. 35-39. Date of Electronic Publication: 2020 Dec 02. - Publication Year :
- 2021
-
Abstract
- Background: Variations by hospital and region in the selection of an early invasive strategy (EIS) after non-ST-segment elevation myocardial infarction (NSTEMI) in patients with high-risk criteria are unknown.<br />Methods: We evaluated the data of 7037 patients with NSTEMI from 20 hospitals of 3 regions from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. We used hierarchical generalized linear mixed-models to estimate region- and hospital-level variation in the selection of an EIS after adjusting for patient-level high-risk criteria. We explored the variation using the median rate ratio (MRR), which estimates the relative difference in the risk ratios of two hypothetically identical patients at two different sites.<br />Results: An EIS was selected in 84.4% of patients. At the hospital level, the median selection rate was 80.4%. At the region level, the median selection rate was 74.9% in the east region, 81.3% in the north region, and 83.9% in the west region, respectively. After adjusting for patient-level covariates, we found significant hospital- (MRR 2.19, 95% confidence interval [CI]: 1.74-3.03) and region-level (MRR 1.88, 95%CI: 1.26-5.44) variation in the selection of an EIS. Among patient-level factors, male sex, ongoing chest pain, history of coronary artery disease or acute heart failure, and GRACE risk score > 140 were independently associated with the selection of an EIS.<br />Conclusions: We observed significant hospital- and region-level variation in the selection of an EIS after NSTEMI in high-risk patients. Quality improvement efforts are required to standardize decision making and to improve clinical outcomes.<br />Competing Interests: Declaration of Competing Interest None.<br /> (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Subjects :
- Coronary Angiography
Hospital Mortality
Humans
Male
Registries
Risk Factors
Treatment Outcome
Coronary Artery Disease
Myocardial Infarction diagnosis
Myocardial Infarction epidemiology
Myocardial Infarction therapy
Non-ST Elevated Myocardial Infarction diagnostic imaging
Non-ST Elevated Myocardial Infarction epidemiology
ST Elevation Myocardial Infarction
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 328
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 33278418
- Full Text :
- https://doi.org/10.1016/j.ijcard.2020.11.059