Among 10,266 NSTEMI patients in China, coronary angiography was performed in 45.6% and revascularization in 40.9%, which was associated with reduced in-hospital MACCE (overall rate 6.7%).
Observational (n=10,266)
Yes
Does invasive management reduce in-hospital MACCE and length of stay in patients with NSTEMI?
Invasive management for NSTEMI is significantly underutilized in China, particularly in lower-tier hospitals and among high-risk patients, despite being associated with improved in-hospital outcomes.
BACKGROUND: Few studies have investigated the use of invasive strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) in China. We aimed to describe the contemporary pattern of management, medically and invasively, in patients with NSTEMI across China. METHODS: Using data of China Acute Myocardial Infarction Registry, we analyzed the baseline characteristics, in-hospital medication, index coronary angiography (CAG) and revascularization by stratification of gender, age, and risk assessment. Primary outcomes included in-hospital major adverse cardio-cerebral events (MACCE, a composite of all-cause death, myocardial (re)infarction, and stroke) and length of stay (LOS). RESULTS: A total of 10,266 NSTEMI patients were enrolled between January 2013 and November 2016. Dual antiplatelet therapy and statins were prescribed in 92.9% and 92.1% of overall patients respectively. CAG was performed in 45.6% of these patients, and 40.9% had an index revascularization. Female, older or higher risk patients were less likely to receive CAG or revascularization. The rates of CAG were 67.9% in the provincial-level, 46.2% in the prefectural, and 12.1% in the county-level hospitals. Of those patients undergoing revascularization, 77.0% (1,156/1,501) very-high-risk patients received urgent revascularization and 16.2% (440/2,699) high-risk patients underwent early revascularization as recommended. The overall in-hospital MACCE was 6.7%, and the median LOS was 10 (6) days. Revascularization was associated with reduction for in-hospital MACCE regardless of risk and age. CONCLUSION: Invasive management was underused and profoundly deferred among patients with NSTEMI in China. The risk-treatment paradox, procedure deferral and medical resources distribution imbalance may represent opportunities for improvement.
Leng et al. (Wed,) conducted a observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=10,266). Invasive management (coronary angiography and revascularization) vs. Medical management was evaluated on In-hospital major adverse cardio-cerebral events (MACCE, a composite of all-cause death, myocardial (re)infarction, and stroke) and length of stay (LOS). Among 10,266 NSTEMI patients in China, coronary angiography was performed in 45.6% and revascularization in 40.9%, which was associated with reduced in-hospital MACCE (overall rate 6.7%).
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