TRENDS OF EARLY INVASIVE STRATEGY FOR PATIENTS WITH NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION: ANALYSIS OF A NATIONAL INPATIENT SAMPLE (2011-2018)

Abstract

SESSION TITLE: Cardiovascular Disease and Comorbidities: Relevance to Clinical PracticeSESSION TYPE: Original InvestigationsPRESENTED ON: 10/18/22 2:45 pm - 3:45 pmPURPOSE: In high-risk NSTEMI patients, an early invasive strategy (EIS), defined as coronary angiography (CA) ± PCI (when appropriate) within 24 hours of presentation is a Class I recommendation per the 2014 AHA/ACC guidelines. We aimed to investigate the temporal trends of the use of an EIS in the US between 2011 and 2018.METHODS: We queried the Healthcare Cost and Utilization National Inpatient Sample 2011-2018. EIS was defined as CA ± revascularization within day 0 or 1 of admission. Descriptive and comparative statistics were performed.RESULTS: From 2011-2018, a total of 3,528,951 admissions for NSTEMI were identified. Of these admissions, 66.2% (n=2,334,900) underwent CA during admission, and 45% (n=1,589,582) underwent EIS. The prevalence of CA during admission in NSTEMI has increased over time; however, the percentage of EIS/CA showed a negative trend (Figure 1). The percentage of NSTEMI cases with CA during admission were comparable between admissions during weekdays (66.5%, n=1,743,578) vs weekends (65.2%, n=591,321); however, EIS was less prevalent during weekend admissions [35.6% (n=323,026) vs 48.3% (n=1,266,555)].CONCLUSIONS: The number of admissions for NSTEMI has been rising between the years 2011 and 2018. Whether this increase is due to better recognition of NSTEMI (in part due to the utilization of higher sensitive troponin assays) or due to higher true incidence (in part due to the increase in life expectancy and comorbidities during this time period) is yet to be investigated. The barriers to EIS must be further explored to ensure ongoing improvement in clinical outcomes.CLINICAL IMPLICATIONS: Early invasive strategy has been shown to be associated with improved outcomes in patients with high-risk NSTEMI. Nontheless, we observed a downtrend in the performance of EIS, especially on weekends. The effect of this downtrend on patients outcomes remain to be investigated.DISCLOSURES: No relevant relationships by Firas AjamNo relevant relationships by Abbas AlshamiNo relevant relationships by Steven DouediNo relevant relationships by Anton MararenkoNo relevant relationships by Mihir OdakNo relevant relationships by Brett SealoveNo relevant relationships by Jeffrey SelanNo relevant relationships by Vandan Upadhyaya SESSION TITLE: Cardiovascular Disease and Comorbidities: Relevance to Clinical Practice SESSION TYPE: Original Investigations PRESENTED ON: 10/18/22 2:45 pm - 3:45 pm PURPOSE: In high-risk NSTEMI patients, an early invasive strategy (EIS), defined as coronary angiography (CA) ± PCI (when appropriate) within 24 hours of presentation is a Class I recommendation per the 2014 AHA/ACC guidelines. We aimed to investigate the temporal trends of the use of an EIS in the US between 2011 and 2018. METHODS: We queried the Healthcare Cost and Utilization National Inpatient Sample 2011-2018. EIS was defined as CA ± revascularization within day 0 or 1 of admission. Descriptive and comparative statistics were performed. RESULTS: From 2011-2018, a total of 3,528,951 admissions for NSTEMI were identified. Of these admissions, 66.2% (n=2,334,900) underwent CA during admission, and 45% (n=1,589,582) underwent EIS. The prevalence of CA during admission in NSTEMI has increased over time; however, the percentage of EIS/CA showed a negative trend (Figure 1). The percentage of NSTEMI cases with CA during admission were comparable between admissions during weekdays (66.5%, n=1,743,578) vs weekends (65.2%, n=591,321); however, EIS was less prevalent during weekend admissions [35.6% (n=323,026) vs 48.3% (n=1,266,555)]. CONCLUSIONS: The number of admissions for NSTEMI has been rising between the years 2011 and 2018. Whether this increase is due to better recognition of NSTEMI (in part due to the utilization of higher sensitive troponin assays) or due to higher true incidence (in part due to the increase in life expectancy and comorbidities during this time period) is yet to be investigated. The barriers to EIS must be further explored to ensure ongoing improvement in clinical outcomes. CLINICAL IMPLICATIONS: Early invasive strategy has been shown to be associated with improved outcomes in patients with high-risk NSTEMI. Nontheless, we observed a downtrend in the performance of EIS, especially on weekends. The effect of this downtrend on patients outcomes remain to be investigated. DISCLOSURES: No relevant relationships by Firas Ajam No relevant relationships by Abbas Alshami No relevant relationships by Steven Douedi No relevant relationships by Anton Mararenko No relevant relationships by Mihir Odak No relevant relationships by Brett Sealove No relevant relationships by Jeffrey Selan No relevant relationships by Vandan Upadhyaya