Key result
Admission to a hospital without an on-site CathLab did not independently predict an adverse outcome of death, in-hospital MI, and re-admission for ACS (OR 1.104; 95% CI 0.734-1.660).
Why the study?
Does admission to a hospital with an on-site CathLab improve 30-day outcomes in patients with NSTEACS compared to hospitals without a CathLab?
Observational (n=1,888)
Yes
Does admission to a hospital with an on-site CathLab improve 30-day outcomes in patients with NSTEACS compared to hospitals without a CathLab?
Odds Ratio: 1.104 (95% CI 0.734–1.66)
In a nationwide Italian registry of NSTEACS patients, admission to a hospital with an on-site CathLab did not independently predict better 30-day clinical outcomes compared to hospitals without a CathLab.
No independent outcome difference by on-site CathLab in NSTEACS; leaves open value of routine transfer in prospective trials.
AIMS: Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network. METHODS AND RESULTS: The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660). CONCLUSION: According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
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Chiara et al. (2005) conducted an observational in Acute coronary syndromes without ST-segment elevation (NSTEACS) (n=1,888). Admission to hospital without CathLab vs. Admission to hospital with CathLab was evaluated on Adverse outcome (death, in-hospital MI, and re-admission for ACS) (OR 1.104, 95% CI 0.734-1.660). Admission to a hospital without an on-site CathLab did not independently predict an adverse outcome of death, in-hospital MI, and re-admission for ACS (OR 1.104; 95% CI 0.734-1.660).
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