Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK.
Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Eur Heart J Qual Care Clin Outcomes. 2022 Sep 5;8(6):681-691. doi: 10.1093/ehjqcco/qcab062.
Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI).
We analysed data from 337 155 NSTEMI admissions between 2010 and 2017 in the UK Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70 y vs. 75 y, P < 0.001), and less likely to be female (33% vs. 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs. 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs. 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs. 59%, P < 0.001), and receive revascularisation in the form of PCI (52% vs. 36%, P < 0.001). Following multivariable logistic regression, the odds of inhospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward.
Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
对于非 ST 段抬高型心肌梗死（NSTEMI）患者，其入院病房类型与护理质量和结局之间的关联尚不清楚。
我们分析了 2010 年至 2017 年英国心肌梗死国家审计项目（MINAP）数据库中 337155 例 NSTEMI 入院患者的数据。该队列根据入院时接受的医疗（n=142876）或心脏病房护理，包括急性心脏病房和心脏监护病房（n=194279）进行二分法。与入住心脏病房的患者相比，患者年龄更小（中位数年龄 70 岁 vs. 75 岁，P < 0.001），女性比例更低（33% vs. 40%，P < 0.001）。与入住心脏病房相关的独立因素包括缺血性心电图改变（OR：1.20，95%CI：1.18-1.23）和经皮冠状动脉介入治疗（PCI）史（OR：1.19，95%CI：1.16-1.22）。入住心脏病房的患者出院时更有可能接受最佳的药物治疗，包括他汀类药物（85% vs. 81%，P < 0.001）和双重抗血小板治疗（DAPT）（91% vs. 88%，P < 0.001），接受经皮冠状动脉造影（78% vs. 59%，P < 0.001），并接受 PCI 形式的血运重建（52% vs. 36%，P < 0.001）。多变量逻辑回归后，与入住医疗病房相比，入住心脏病房的患者院内全因死亡率（OR：0.75，95%CI：0.70-0.81）和主要不良心血管事件（MACE）（OR：0.84，95%CI：0.78-0.91）的发生风险更低。
入院时入住心脏病房的 NSTEMI 患者更有可能接受指南指导的治疗，且临床结局更好。
