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January 1, 2014BMJ OpenOpen Access

Trends 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 Denmark

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Key result

Between 2007 and 2009, the 3-day probability of coronary angiography for NSTEMI increased from 20% to 39%, and the probability of PCI increased from 19% to 28%.

Population

65,909 patients with first-time hospitalisations for non-ST elevation myocardial infarction and unstable…

Design

Cohort

Follow-up

60 days

Authors

SMSolvej MårtenssonDGDorte Gyrd‐HansenEPEva Prescott

Discussion

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Overview

Early angiography/PCI uptake for NSTEMI rose over time; extends temporal trends but leaves outcome benefits open in observational data.

Key Points

  • To evaluate nationwide trends in time from admission to invasive cardiovascular examination and revascularization among patients with first-time non-ST elevation myocardial infarction or unstable angina.
  • Nationwide cohort study of 65,909 first-time hospitalizations for NSTEMI and unstable angina identified in the Danish National Patient Registry from 2001 to 2009.
  • Tracked cumulative probabilities of coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) at 3, 7, 10, 30, and 60 days.
  • Accounted for the competing risk of death using Aalen-Johansen estimators and Fine-Gray regression modeling.
  • Overall utilization of CAG and PCI increased markedly across the study period, while the proportion of patients managed with CABG declined for both diagnoses.
  • For NSTEMI, the 3-day probability of CAG increased from 20% in 2007 to 32% in 2008 and 39% in 2009, while 3-day PCI probability rose from 19% in 2008 to 28% in 2009.
  • Early invasive assessment probability at 3 days increased significantly for both conditions, demonstrating sharp accelerations in clinical decision-making and revascularization between 2007 and 2009.

Study Design

Type

Cohort (n=65,909)

Multicenter

Yes

Structured PICO

P
Population
65,909 patients with first-time hospitalizations for NSTEMI or unstable angina in Denmark between 2001 and 2009.
E
Exposure
Invasive examination and treatment (coronary angiography [CAG], percutaneous coronary intervention [PCI], or coronary artery bypass graft [CABG])
O
Outcome
Time from admission to initiation of coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), assessed as probability at 3, 7, 10, 30 and 60 days

Main Result

Absolute Event Rate: 39% vs 20%

There was a substantial increase in the early use of coronary angiography and PCI for NSTEMI and unstable angina in Denmark from 2001 to 2009, aligning with goals to reduce time to treatment.

Cite This Study

Mårtensson et al. (2014) conducted a cohort in Non-ST elevation myocardial infarction (NSTEMI) and unstable angina (n=65,909). Calendar year of admission (2001-2009) vs. Earlier calendar years was evaluated on Invasive examination and treatment probability at 3 days. Between 2007 and 2009, the 3-day probability of coronary angiography for NSTEMI increased from 20% to 39%, and the probability of PCI increased from 19% to 28%.

synapsesocial.com/papers/6a94460ccd4df3c00e00a2b6https://doi.org/10.1136/bmjopen-2013-004052
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