Use and Timing of Coronary Angiography and Associated In-hospital Outcomes in Canadian Non–ST-Segment Elevation Myocardial Infarction Patients: Insights from the Canadian Global Registry of Acute Coronary Events

• Published in: Canadian journal of cardiology Vol. 29; no. 11; pp. 1429 - 1435
• Main Authors: Gyenes, Gabor T., MD, PhD, Yan, Andrew T., MD, Tan, Mary, MSc, Welsh, Robert C., MD, Fox, Keith A.A., MB, ChB, Grondin, Francois R., MD, DeYoung, J. Paul, MD, Rose, Barry F., MD, Gallo, Richard, MD, Kornder, Jan M., MD, Wong, Graham C., MD, Goodman, Shaun G., MD, MSc
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.11.2013
• Subjects: Aged; Canada - epidemiology; Cardiac Catheterization; Cardiovascular; Coronary Angiography - statistics & numerical data; Female; Heart Failure - epidemiology; Hospital Mortality; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - epidemiology; Myocardial Infarction - therapy; Myocardial Ischemia - epidemiology; Myocardial Revascularization; Patient Admission - statistics & numerical data; Registries; Retrospective Studies; Risk Assessment; Time Factors; Canada
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2013.04.035

Abstract Background Although an early invasive approach has become standard strategy for the management of non–ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain. Methods We examined the use and timing of coronary angiography, revascularization, and cardiovascular outcomes of NSTEMI patients: (1) admitted on weekdays vs weekends; and (2) stratified according to presentation risk level, in the Canadian Global Registry of Acute Coronary Events (GRACE)/Expanded GRACE (GRACE2 )/Canadian Registry of Acute Coronary Events (CANRACE) population. Results Of 6711 NSTEMI patients, 1956 (29.1%) were admitted on the weekend. The median (interquartile range) wait time for coronary angiography was 58 (32-106) and 70 (50-112) hours for weekday and weekend patients, respectively ( P  = 0.32). Compared with lower-intermediate risk, higher-risk patients were less likely to undergo angiography (44.7% vs 69.7% for weekdays and 45.2% vs 69.6% for weekends; both P < 0.0001) and waited longer for angiography (median 71 vs 61 hours; P < 0.0001). Weekend admission was independently associated with higher mortality (adjusted odds ratio [OR], 1.52; 95% confidence interval [CI], 1.15-2.01; P  = 0.004), recurrent ischemia (adjusted OR, 1.16; 95% CI, 1.01-1.32; P  = 0.03), and heart failure (adjusted OR, 1.28; 95% CI, 1.00-1.63; P  = 0.048) but not with reinfarction. Conclusions Median wait time for angiography in Canadian NSTEMI patients admitted on the weekend was not significantly longer than for those who presented on a weekday. Patients admitted on weekends had higher adjusted mortality and cardiovascular event rates. Higher-risk patients were less likely to undergo angiography and waited longer, with higher observed in-hospital event rates. Systematic, guideline-recommended risk stratification should be considered to ensure that optimal management strategies (eg, timely coronary angiography in higher-risk patients) are matched to level of risk.