Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2013 Nov;29(11):1429-35. doi: 10.1016/j.cjca.2013.04.035. Epub 2013 Jul 30.
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.
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 (GRACE(2))/Canadian Registry of Acute Coronary Events (CANRACE) population.
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.
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.
尽管早期侵入性方法已成为非 ST 段抬高型心肌梗死（NSTEMI）管理的标准策略，但在加拿大，其应用频率和时间尚不确定。
我们研究了 NSTEMI 患者的冠状动脉造影、血运重建和心血管结局的使用和时间：（1）在工作日与周末入院；（2）根据就诊风险水平分层，在加拿大全球急性冠状动脉事件登记处（GRACE）/扩展 GRACE（GRACE(2)）/加拿大急性冠状动脉事件登记处（CANRACE）人群中。
在 6711 例 NSTEMI 患者中，1956 例（29.1%）在周末入院。与工作日患者相比，周末患者接受冠状动脉造影的中位（四分位距）等待时间分别为 58（32-106）和 70（50-112）小时（P = 0.32）。与低-中危患者相比，高危患者更不可能接受血管造影检查（工作日分别为 44.7%和 69.7%，周末分别为 45.2%和 69.6%；均 P<0.0001），且血管造影等待时间更长（中位时间分别为 71 小时和 61 小时；均 P<0.0001）。周末入院与更高的死亡率（校正优势比[OR]，1.52；95%置信区间[CI]，1.15-2.01；P = 0.004）、复发性缺血（校正 OR，1.16；95%CI，1.01-1.32；P = 0.03）和心力衰竭（校正 OR，1.28；95%CI，1.00-1.63；P = 0.048）独立相关，但与再梗死无关。
加拿大 NSTEMI 患者周末入院与工作日入院相比，接受血管造影的中位等待时间并无显著延长。周末入院的患者校正死亡率和心血管事件发生率更高。高危患者更不可能接受血管造影检查，且等待时间更长，观察到的院内事件发生率更高。应考虑进行系统的、符合指南的风险分层，以确保将最佳管理策略（例如，高危患者的及时冠状动脉造影）与风险水平相匹配。
