Supples Michael W, Snavely Anna C, Ashburn Nicklaus P, Koehler Lauren E, Stopyra Jason P, Park Carolyn J, Vasu Sujethra, Kutcher Michael, Hundley Gregory, Mahler Simon A, Miller Chadwick
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Am J Emerg Med. 2025 Apr;90:200-204. doi: 10.1016/j.ajem.2025.01.073. Epub 2025 Jan 27.
Heterogeneity is observed in the care of patients with chest pain. We investigate the association of physician specialty and diagnostic testing among patients admitted for suspected acute coronary syndrome (ACS).
This is a secondary analysis of the CMR-IMPACT multicenter randomized controlled trial in which patients with suspected ACS were admitted and randomized to undergo invasive angiography or non-invasive CMR stress imaging. Admitting physician was dichotomized to interventional cardiologist (IC) or not (e.g. hospitalist). We describe adherence to protocol and angiography during the index visit by treatment arm and admitting physician specialty. A generalized estimating equation accounting for clustering within physician was used to evaluate significance and adjusted for randomization arm.
The 258 enrolled patients from 2013 to 2018 had a mean age of 60.7 (SD ± 10.9) years, 40.3 % (104/258 were female), and 64.7 % (167/258) were white race. ICs were the admitting physicians for 50.4 % (130/258) of the patients. Index angiography was performed more often among patients admitted by IC versus other physicians, 65.4 % (85/130) versus 53.1 % (68/128), respectively; aOR 1.75 (95 % CI 1.14-2.68). Among patients randomized to an invasive strategy, higher protocol adherence was observed in those admitted by IC [85.3 % (58/68)] versus other physicians [64.5 % (40/62)]; OR 2.82 (95 % CI 1.08-7.38). For patients randomized to the CMR-based strategy, adherence to protocol was similar for IC [67.7 % (42/62)] and other physicians [66.7 % (44/66)]; OR 0.82 (95 % CI 0.35-1.94).
Invasive angiography was more frequent among patients admitted by interventional cardiologists compared to other physicians.
胸痛患者的护理存在异质性。我们调查了因疑似急性冠状动脉综合征（ACS）入院患者的医生专业与诊断测试之间的关联。
这是对CMR-IMPACT多中心随机对照试验的二次分析，该试验中，疑似ACS患者入院并随机接受有创血管造影或无创CMR负荷成像。将收治医生分为介入心脏病专家（IC）和非介入心脏病专家（如住院医生）。我们按治疗组和收治医生专业描述了首次就诊时对方案和血管造影的依从性。使用考虑医生内部聚类的广义估计方程来评估显著性，并对随机分组进行了调整。
2013年至2018年纳入的258例患者的平均年龄为60.7（标准差±10.9）岁，40.3%（104/258）为女性，64.7%（167/258）为白人。IC是50.4%（130/258）患者的收治医生。IC收治的患者中进行首次血管造影检查的比例高于其他医生，分别为65.4%（85/130）和53.1%（68/128）；调整后比值比为1.75（95%置信区间1.14-2.68）。在随机接受有创策略的患者中，IC收治的患者[85.3%（58/68）]比其他医生收治的患者[64.5%（40/62）]有更高的方案依从性；比值比为2.82（95%置信区间1.08-7.38）。对于随机接受基于CMR策略的患者，IC[67.7%（42/62）]和其他医生[66.
