Lima Fabio V, Kennedy Kevin F, Saad Marwan, Kolte Dhaval, Foley Katelyn, Abbott J Dawn, Aronow Herbert D
Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Statistical Consultant, Kansas City, Missouri.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 26;2(1):100532. doi: 10.1016/j.jscai.2022.100532. eCollection 2023 Jan-Feb.
Although variation in the management of patients with non-ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing variation in outcomes following specific management strategies.
Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included variation in length of stay (LOS), cost, and use of each treatment modality. Variation was characterized by the median odds ratio.
Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality.
In a large national analysis of hospitalizations for NSTEMI, significant variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors.
尽管美国各医院对非ST段抬高型心肌梗死（NSTEMI）患者的治疗差异已有充分记录，但关于特定治疗策略后结局差异的数据却很少。
从国家住院患者样本中识别出2016年至2018年间因NSTEMI入住进行冠状动脉造影、经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的医院的患者。根据所接受的治疗（单纯药物治疗、未进行血运重建的血管造影、PCI或CABG）对患者进行分类。主要终点是按所接受的治疗分层的院内死亡、术后心肌梗死或中风复合发生率的差异。次要结局包括住院时间（LOS）、费用以及每种治疗方式使用情况的差异。差异以中位数优势比来表征。
在140194例NSTEMI住院病例中，35748例（25.5%）患者仅接受药物治疗，28678例（20.5%）接受了未进行血运重建的血管造影，58383例（41.6%）接受了PCI，17385例（12.4%）接受了CABG。尽管对患者和医院相关因素进行了调整，但在1家随机选择的医院中，2例相似患者接受PCI后发生复合主要结局的可能性比在另一家医院高25%，接受CABG后高45%。每种治疗方式后，住院时间和费用在医院层面也存在显著差异。
在一项对NSTEMI住院病例的大型全国性分析中，尽管对患者和医院相关因素进行了调整，但每种治疗方式在临床结局、住院时间和费用方面仍存在显著差异。
