Abstract 244: Identifying Differences in Demographics, Management, and Outcomes Between Type 1 and Type 2 NSTEMI Patients

Abstract

Background: A type 2 NSTEMI (T2) is defined as ischemia secondary to another condition resulting in either an increase in myocardial oxygen demand or decrease in oxygen supply. Little is known about this population or management. This study sought to compare demographics, outcomes, and the utility of a cardiac transitional care program (BRIDGE) between type 1 (T1) and T2 patients. Methods: The BRIDGE database was queried for patients referred between 2012-2017 with a primary discharge diagnosis of NSTEMI. Patients were randomly selected and classified as either T1 or T2 NSTEMI based on a retrospective chart review using criteria proposed by Saaby et al. (2013). Demographics, discharge medications, and outcomes (BRIDGE attendance, readmission, ED visits, death) were compared between groups. Results: Of 149 NSTEMI patients, 33 (22.1%) were T2. A higher percentage of T2 were female. T2 were more likely to have anemia and had longer hospital stays. At discharge, T2 patients were less likely to be prescribed medications for secondary prevention; specifically, aspirin, antiplatelets, or nitrates. T2 patients were less likely to attend their BRIDGE appointment. Comparison of cumulative adverse events at 180 days post-discharge was suggestive of worse outcomes for T2 patients. Conclusions: Management of the T2 NSTEMI patient depends on the underlying condition. This poses a challenge for developing universal standards. A larger sample is needed to identify standards that may be appropriate for all T2 NSTEMI patients and to identify T2 NSTEMI subsets that may share similar management strategies.