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Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry
Background An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics asso...
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| Published in: | Netherlands heart journal 2019-02, Vol.27 (2), p.73-80 |
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| container_end_page | 80 |
| container_issue | 2 |
| container_start_page | 73 |
| container_title | Netherlands heart journal |
| container_volume | 27 |
| creator | Badings, E. A. Hermanides, R. S. Van Der Sluis, A. Dambrink, J. H. E. Gosselink, A. T. M. Kedhi, E. Ottervanger, J. P. Roolvink, V. Remkes, W. S. van’t Riet, E. Suryapranata, H. van’t Hof, A. W. J. |
| description | Background
An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome.
Methods
In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared.
Results
Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (
p
trend |
| doi_str_mv | 10.1007/s12471-018-1212-3 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6352622</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2157665834</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-9ce060b695dc2e2017c91c0d7cb9128ee7952a124a07b14fa7ae9e9e4d2e4cb93</originalsourceid><addsrcrecordid>eNp1kk1u1TAUhSMEoj-wACbIEhMGNdhOHCcMKqGKP6kSA9qx5efc5LkkdrCTV2XWZcCMtbAAFtGVcJ9eaQEJeWDL5_O5vlcny55w9oIzpl4mLgrFKeMV5YILmt_L9nmlSloKye7jWZYVlVVV7WUHKV0wJpXg6mG2lzNZqILn-9nP8wRHZHKD8x0xviFhnmwYgISW2BCDN3HB-86FLppxvRDnyWgmB35K5NJNa7J23ZpGlz4THzz9dEYTdAPKBHrYIBk8MXae4M4uLb6J2xro1RjXL8T2zjtrejJGYydn4RVqCY2xSIsoMT--X199jYDIZYh9c331DdmQRkB8AyRC59IUl0fZg9b0CR7f7IfZ-ds3Zyfv6enHdx9OXp9SWyg20doCK9mqrGVjBQjGla25ZY2yq5qLCkDVUhicrmFqxYvWKAM1rqIRUCCTH2bHO99xXg3QWOw3ml6P0Q3YoQ7G6b8V79a6Cxtd5lKUQqDB8xuDGL7MkCY9uGSh742HMCctuFRlKau8QPTZP-hFmKPH9rRQopY5-jGk-I6yOJYUob39DGd6mxa9S4vGtOhtWnSOb57-2cXti9_xQEDsgISS7yDelf6_6y9mU9Om</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2729536220</pqid></control><display><type>article</type><title>Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry</title><source>Access via ProQuest (Open Access)</source><source>Springer Nature - SpringerLink Journals - Fully Open Access</source><source>PubMed Central</source><creator>Badings, E. A. ; Hermanides, R. S. ; Van Der Sluis, A. ; Dambrink, J. H. E. ; Gosselink, A. T. M. ; Kedhi, E. ; Ottervanger, J. P. ; Roolvink, V. ; Remkes, W. S. ; van’t Riet, E. ; Suryapranata, H. ; van’t Hof, A. W. J.</creator><creatorcontrib>Badings, E. A. ; Hermanides, R. S. ; Van Der Sluis, A. ; Dambrink, J. H. E. ; Gosselink, A. T. M. ; Kedhi, E. ; Ottervanger, J. P. ; Roolvink, V. ; Remkes, W. S. ; van’t Riet, E. ; Suryapranata, H. ; van’t Hof, A. W. J.</creatorcontrib><description>Background
An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome.
Methods
In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared.
Results
Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (
p
trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5 h (
p
trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (
p
trend = 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1‑year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12–2.49) but was comparable after adjustment for confounding factors.
Conclusion
The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk.</description><identifier>ISSN: 1568-5888</identifier><identifier>EISSN: 1876-6250</identifier><identifier>DOI: 10.1007/s12471-018-1212-3</identifier><identifier>PMID: 30547413</identifier><language>eng</language><publisher>Houten: Bohn Stafleu van Loghum</publisher><subject>Acute coronary syndromes ; Cardiology ; Clinical medicine ; Diabetes ; Enzymes ; Heart attacks ; Hospitalization ; Ischemia ; Medical Education ; Medical imaging ; Medicine ; Medicine & Public Health ; Mortality ; Original ; Original Article ; Patients ; Regression analysis ; Statistical analysis ; Trends ; Variance analysis</subject><ispartof>Netherlands heart journal, 2019-02, Vol.27 (2), p.73-80</ispartof><rights>The Author(s) 2018</rights><rights>The Author(s) 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-9ce060b695dc2e2017c91c0d7cb9128ee7952a124a07b14fa7ae9e9e4d2e4cb93</citedby><cites>FETCH-LOGICAL-c470t-9ce060b695dc2e2017c91c0d7cb9128ee7952a124a07b14fa7ae9e9e4d2e4cb93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2729536220/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2729536220?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30547413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Badings, E. A.</creatorcontrib><creatorcontrib>Hermanides, R. S.</creatorcontrib><creatorcontrib>Van Der Sluis, A.</creatorcontrib><creatorcontrib>Dambrink, J. H. E.</creatorcontrib><creatorcontrib>Gosselink, A. T. M.</creatorcontrib><creatorcontrib>Kedhi, E.</creatorcontrib><creatorcontrib>Ottervanger, J. P.</creatorcontrib><creatorcontrib>Roolvink, V.</creatorcontrib><creatorcontrib>Remkes, W. S.</creatorcontrib><creatorcontrib>van’t Riet, E.</creatorcontrib><creatorcontrib>Suryapranata, H.</creatorcontrib><creatorcontrib>van’t Hof, A. W. J.</creatorcontrib><title>Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry</title><title>Netherlands heart journal</title><addtitle>Neth Heart J</addtitle><addtitle>Neth Heart J</addtitle><description>Background
An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome.
Methods
In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared.
Results
Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (
p
trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5 h (
p
trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (
p
trend = 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1‑year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12–2.49) but was comparable after adjustment for confounding factors.
Conclusion
The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk.</description><subject>Acute coronary syndromes</subject><subject>Cardiology</subject><subject>Clinical medicine</subject><subject>Diabetes</subject><subject>Enzymes</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Ischemia</subject><subject>Medical Education</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Trends</subject><subject>Variance analysis</subject><issn>1568-5888</issn><issn>1876-6250</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNp1kk1u1TAUhSMEoj-wACbIEhMGNdhOHCcMKqGKP6kSA9qx5efc5LkkdrCTV2XWZcCMtbAAFtGVcJ9eaQEJeWDL5_O5vlcny55w9oIzpl4mLgrFKeMV5YILmt_L9nmlSloKye7jWZYVlVVV7WUHKV0wJpXg6mG2lzNZqILn-9nP8wRHZHKD8x0xviFhnmwYgISW2BCDN3HB-86FLppxvRDnyWgmB35K5NJNa7J23ZpGlz4THzz9dEYTdAPKBHrYIBk8MXae4M4uLb6J2xro1RjXL8T2zjtrejJGYydn4RVqCY2xSIsoMT--X199jYDIZYh9c331DdmQRkB8AyRC59IUl0fZg9b0CR7f7IfZ-ds3Zyfv6enHdx9OXp9SWyg20doCK9mqrGVjBQjGla25ZY2yq5qLCkDVUhicrmFqxYvWKAM1rqIRUCCTH2bHO99xXg3QWOw3ml6P0Q3YoQ7G6b8V79a6Cxtd5lKUQqDB8xuDGL7MkCY9uGSh742HMCctuFRlKau8QPTZP-hFmKPH9rRQopY5-jGk-I6yOJYUob39DGd6mxa9S4vGtOhtWnSOb57-2cXti9_xQEDsgISS7yDelf6_6y9mU9Om</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Badings, E. A.</creator><creator>Hermanides, R. S.</creator><creator>Van Der Sluis, A.</creator><creator>Dambrink, J. H. E.</creator><creator>Gosselink, A. T. M.</creator><creator>Kedhi, E.</creator><creator>Ottervanger, J. P.</creator><creator>Roolvink, V.</creator><creator>Remkes, W. S.</creator><creator>van’t Riet, E.</creator><creator>Suryapranata, H.</creator><creator>van’t Hof, A. W. J.</creator><general>Bohn Stafleu van Loghum</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190201</creationdate><title>Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry</title><author>Badings, E. A. ; Hermanides, R. S. ; Van Der Sluis, A. ; Dambrink, J. H. E. ; Gosselink, A. T. M. ; Kedhi, E. ; Ottervanger, J. P. ; Roolvink, V. ; Remkes, W. S. ; van’t Riet, E. ; Suryapranata, H. ; van’t Hof, A. W. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-9ce060b695dc2e2017c91c0d7cb9128ee7952a124a07b14fa7ae9e9e4d2e4cb93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute coronary syndromes</topic><topic>Cardiology</topic><topic>Clinical medicine</topic><topic>Diabetes</topic><topic>Enzymes</topic><topic>Heart attacks</topic><topic>Hospitalization</topic><topic>Ischemia</topic><topic>Medical Education</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Trends</topic><topic>Variance analysis</topic><toplevel>online_resources</toplevel><creatorcontrib>Badings, E. A.</creatorcontrib><creatorcontrib>Hermanides, R. S.</creatorcontrib><creatorcontrib>Van Der Sluis, A.</creatorcontrib><creatorcontrib>Dambrink, J. H. E.</creatorcontrib><creatorcontrib>Gosselink, A. T. M.</creatorcontrib><creatorcontrib>Kedhi, E.</creatorcontrib><creatorcontrib>Ottervanger, J. P.</creatorcontrib><creatorcontrib>Roolvink, V.</creatorcontrib><creatorcontrib>Remkes, W. S.</creatorcontrib><creatorcontrib>van’t Riet, E.</creatorcontrib><creatorcontrib>Suryapranata, H.</creatorcontrib><creatorcontrib>van’t Hof, A. W. J.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Netherlands heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Badings, E. A.</au><au>Hermanides, R. S.</au><au>Van Der Sluis, A.</au><au>Dambrink, J. H. E.</au><au>Gosselink, A. T. M.</au><au>Kedhi, E.</au><au>Ottervanger, J. P.</au><au>Roolvink, V.</au><au>Remkes, W. S.</au><au>van’t Riet, E.</au><au>Suryapranata, H.</au><au>van’t Hof, A. W. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry</atitle><jtitle>Netherlands heart journal</jtitle><stitle>Neth Heart J</stitle><addtitle>Neth Heart J</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>27</volume><issue>2</issue><spage>73</spage><epage>80</epage><pages>73-80</pages><issn>1568-5888</issn><eissn>1876-6250</eissn><abstract>Background
An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome.
Methods
In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared.
Results
Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (
p
trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5 h (
p
trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (
p
trend = 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1‑year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12–2.49) but was comparable after adjustment for confounding factors.
Conclusion
The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk.</abstract><cop>Houten</cop><pub>Bohn Stafleu van Loghum</pub><pmid>30547413</pmid><doi>10.1007/s12471-018-1212-3</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Netherlands heart journal, 2019-02, Vol.27 (2), p.73-80 |
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| source | Access via ProQuest (Open Access); Springer Nature - SpringerLink Journals - Fully Open Access; PubMed Central |
| subjects | Acute coronary syndromes Cardiology Clinical medicine Diabetes Enzymes Heart attacks Hospitalization Ischemia Medical Education Medical imaging Medicine Medicine & Public Health Mortality Original Original Article Patients Regression analysis Statistical analysis Trends Variance analysis |
| title | Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a ‘real world’ prospective registry |
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