Varughese Vivek Joseph, Pollock James, Patel Prem, Richardson Chandler, Joseph Cara, Vacca Dominic, Mujadzic Hata
Prisma Health, University of South Carolina School of Medicine, Columbia, SC 29601, USA.
J Clin Med. 2024 Dec 31;14(1):171. doi: 10.3390/jcm14010171.
: The main aim of this study is to analyze the outcomes of NSTEMI admissions and test the relevance of TIMI as a risk score in a real-world setting. We also examine any potential social or health care disparities involved with outcomes of NSTEMI admissions. This study also investigates factors associated with mortality in NSTEMI admissions and its correlation with heart catheterization during admission. : NSTEMI admissions were analyzed using the National Inpatient Sample. TIMI scores were calculated for the admissions and their association with all-cause mortality was studied. Differences in mortality outcomes based on heart catheterization during admission were studied in the subgroup with a TIMI score > 2. Correlations between time to heart catheterization and all-cause mortality in NSTEMI admissions were analyzed. : No significant social or healthcare disparities were noted among outcomes for NSTEMI admissions. NSTEMI admissions with a calculated TIMI score > 2 had a statistically significant association with all-cause mortality during admission: odds ratio 1.33 (95% CI 1.23-1.43, value: 0.00). The prevalence of mortality among NSTEMI admissions with a calculated TIMI score > 2 who did not undergo heart catheterization was higher with statistical significance (6.23%; 95% CI: 5.84-6.65%), when compared to admissions who underwent heart catheterization (2.41%; 95% CI: 2.25-2.59%). NSTEMI admissions with a calculated TIMI score > 2 who underwent catheterization on or beyond the fourth day of hospitalization had a statistically significant association with all-cause mortality during admission: odds ratio: 2.56 (95% CI: 2.31-2.83, value: 0.00). Age at admission, presence of CKD and CHF were associated with mortality in NSTEMI admissions, with statistical significance. : Based on the results of our analysis, no disparities in terms of race/sex/hospital location, etc., were seen for NSTEMI in-hospital outcomes. Admissions with a TIMI score > 2 had a statistically significant association with in-hospital mortality, after accounting for confounders. Among NSTEMI admissions with a TIMI score > 2, those who did not undergo heart catheterization during admission were found to have a higher prevalence of in-hospital mortality. No social or healthcare disparities were seen among admissions with TIMI score > 2 who did not undergo heart catheterization during admission. We also noted that NSTEMI admissions with a TIMI score > 2 who underwent heart catheterization on or beyond Day 4 of the initial admission were associated with higher mortality.
本研究的主要目的是分析非ST段抬高型心肌梗死（NSTEMI）入院患者的治疗结果，并在现实环境中检验心肌梗死溶栓治疗（TIMI）风险评分的相关性。我们还研究了与NSTEMI入院治疗结果相关的任何潜在社会或医疗保健差异。本研究还调查了NSTEMI入院患者的死亡相关因素及其与入院期间心脏导管插入术的相关性。
使用国家住院样本对NSTEMI入院患者进行分析。计算入院患者的TIMI评分，并研究其与全因死亡率的关联。在TIMI评分>2的亚组中，研究入院期间基于心脏导管插入术的死亡率差异。分析NSTEMI入院患者心脏导管插入术时间与全因死亡率之间的相关性。
NSTEMI入院治疗结果之间未发现显著的社会或医疗保健差异。计算得出TIMI评分>2的NSTEMI入院患者与入院期间全因死亡率具有统计学显著关联：比值比为1.33（95%置信区间1.23 - 1.43，P值：0.00）。与接受心脏导管插入术的入院患者（2.41%；95%置信区间：2.25 - 2.59%）相比，计算得出TIMI评分>2但未接受心脏导管插入术的NSTEMI入院患者的死亡率患病率更高，具有统计学显著性（6.23%；95%置信区间：5.84 - 6.65%）。入院时年龄、慢性肾脏病（CKD）和慢性心力衰竭（CHF）的存在与NSTEMI入院患者的死亡率具有统计学显著关联。
根据我们的分析结果，NSTEMI住院治疗结果在种族/性别/医院位置等方面未发现差异。在考虑混杂因素后，TIMI评分>2的入院患者与住院死亡率具有统计学显著关联。在TIMI评分>2的NSTEMI入院患者中，发现入院期间未接受心脏导管插入术的患者住院死亡率患病率更高。在入院期间未接受心脏导管插入术且TIMI评分>2的入院患者之间未发现社会或医疗保健差异。我们还注意到，初次入院第4天及以后接受心脏导管插入术且TIMI评分>2的NSTEMI入院患者与更高的死亡率相关。
