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August 30, 2016JAMAOpen Access

Association of Clinical Factors and Therapeutic Strategies With Improvements in Survival Following Non–ST-Elevation Myocardial Infarction, 2003-2013

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Why the study?

Is the decline in mortality following NSTEMI associated with lower baseline risk, increased use of pharmacological therapies, or the use of an invasive coronary strategy?

Population

389,057 patients with NSTEMI in 247 hospitals in England and Wales, median age 72.7 years, 63.1% men.

Comparison

Use of an invasive coronary strategy and… vs Earlier time periods and non-invasive management.

Design

Cohort

Follow-up

180 days postdischarge

Authors

MHMarlous HallTDTatendashe Bernadette DondoAYAndrew T. Yan

Discussion

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Overview

Invasive strategy use was associated with NSTEMI mortality decline; hypothesis-generating, leaves causal effect and practice change open.

Structured PICO

Is the decline in mortality following NSTEMI associated with lower baseline risk, increased use of pharmacological therapies, or the use of an invasive coronary strategy?

P
Population
389,057 patients with NSTEMI in 247 hospitals in England and Wales, median age 72.7 years, 63.1% men.
I
Intervention
Use of an invasive coronary strategy and pharmacological therapies over time (2003-2013).
C
Comparator
Earlier time periods (2003-2004) and non-invasive management.
O
Outcome
Adjusted all-cause 180-day postdischarge mortality.hard clinical

Improvements in 180-day mortality following NSTEMI between 2003 and 2013 were significantly associated with the increased use of an invasive coronary strategy, rather than solely a decline in baseline clinical risk or increased use of pharmacological therapies.

Cite This Study

Hall et al. (2016) studied this question.

synapsesocial.com/papers/69f69192e405cc4465bc2bd2https://doi.org/10.1001/jama.2016.10766
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Also Consider

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  1. 1Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003–2009: National Institute for Cardiovascular Outcomes Research (NICOR)2012 · 80 citations
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  3. 3The Myocardial Ischaemia National Audit Project (MINAP)2010 · 300 citations
  4. 4Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study2014 · 35 citations
  5. 5High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study2015 · 459 citations