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July 29, 2014Journal of the American Heart AssociationOpen Access

Non‐ST‐Elevation Myocardial Infarction in the United States: Contemporary Trends in Incidence, Utilization of the Early Invasive Strategy, and In‐Hospital Outcomes

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Key result

Risk-adjusted in-hospital mortality for NSTEMI decreased significantly from 2002 to 2011 (adjusted OR per year 0.976; 95% CI 0.974-0.978), alongside increased use of early invasive strategy.

Why the study?

How have the incidence, utilization of early invasive strategy, and in-hospital outcomes for NSTEMI changed in the US from 2002 to 2011?

Population

3,981,119 patients ≥40 years of age with a principal diagnosis of NSTEMI from the 2002-2011 Nationwide…

Comparison

Early invasive strategy (EIS) at day 0 or day 0-1 vs Temporal trends (2002 vs 2011)

Design

Cohort

Follow-up

in-hospital

Authors

SKSahil KheraDKDhaval KolteWAWilbert S. Aronow

Discussion

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Member takes

Overview

NSTEMI mortality decline coincided with rising early invasive use; leaves open causal contribution versus secular trends in this observational cohort.

Study Design

Type

Observational (n=6,512,372)

Multicenter

Yes

Structured PICO

How have the incidence, utilization of early invasive strategy, and in-hospital outcomes for NSTEMI changed in the US from 2002 to 2011?

P
Population
6,512,372 patients aged ≥40 years with a principal diagnosis of acute myocardial infarction from the 2002-2011 Nationwide Inpatient Sample databases.
E
Exposure
Early invasive strategy (EIS) at day 0 or day 0-1
C
Comparator
Temporal trends (2002 vs 2011)
O
Outcome
Incidence of NSTEMI, utilization of early invasive strategy, and in-hospital mortalityhard clinical

Main Result

Odds Ratio: 0.976 (95% CI 0.974–0.978)

Between 2002 and 2011 in the US, the proportion of AMIs presenting as NSTEMI increased, accompanied by greater utilization of early invasive strategies and decreased in-hospital mortality.

Cite This Study

Khera et al. (2014) conducted an observational in Non-ST-elevation myocardial infarction (NSTEMI) (n=6,512,372). Calendar year vs. Previous years was evaluated on Risk-adjusted in-hospital mortality (OR 0.976, 95% CI 0.974-0.978). Risk-adjusted in-hospital mortality for NSTEMI decreased significantly from 2002 to 2011 (adjusted OR per year 0.976; 95% CI 0.974-0.978), alongside increased use of early invasive strategy.

synapsesocial.com/papers/6a82f9cd8847014bd698f858https://doi.org/10.1161/jaha.114.000995
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Trends in Clinical, Demographic, and Biochemical Characteristics of Patients With Acute Myocardial Infarction From 2003 to 2008: A Report From the American Heart Association Get With The Guidelines Coronary Artery Disease Program2012 · 41 citations
  2. 2Trends in time to invasive examination and treatment from 2001 to 2009 in patients admitted first time with non-ST elevation myocardial infarction or unstable angina in Denmark2014 · 25 citations
  3. 3ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction2007 · 1,857 citations
  4. 4Acute Coronary Care in the Elderly, Part I2007 · 916 citations
  5. 52012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update)2012 · 1,095 citations