Utilization of catheterization and revascularization procedures in patients with non-ST segment elevation acute
Glenn N Levine1, A Michael Lincoff, James J Ferguson
1Baylor College of Medicine and the Houston VA Medical Center, Houston, Texas 77030, USA. glevine@bcm.tmc.edu
Insights
This study reviewed invasive procedures for non-ST segment elevation acute coronary syndrome (NSTE-ACS). Percutaneous coronary intervention (PCI) use increased significantly, becoming the primary revascularization method, though most patients still receive medical therapy alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Utilization of cardiac catheterization and revascularization in non-ST segment elevation acute coronary syndrome (NSTE-ACS) impacts treatment strategies and resource allocation.
- Understanding trends in these procedures is crucial for optimizing patient management and healthcare policies.
Purpose of the Study:
- To systematically review large trials and registries over the past decade to assess the utilization of catheterization and revascularization in NSTE-ACS patients.
- To identify trends in procedural management and compare utilization rates between different cohorts.
Main Methods:
- Systematic overview of large clinical trials and patient registries focusing on NSTE-ACS over the last 10 years.
- Analysis of data concerning cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) utilization.
Main Results:
- The majority of NSTE-ACS patients were initially treated with medical therapy alone.
- The proportion of NSTE-ACS patients undergoing diagnostic cardiac catheterization followed by PCI has increased to approximately 50% over the decade.
- PCI is now the predominant revascularization method, used in about 75% of revascularized NSTE-ACS patients.
- Invasive and revascularization procedure rates were higher in U.S. patient cohorts compared to non-U.S. cohorts.
Conclusions:
- While medical therapy remains the primary treatment for most NSTE-ACS patients, there has been a significant rise in the use of PCI for both diagnosis and revascularization.
- PCI has become the leading revascularization strategy for NSTE-ACS patients undergoing procedures.
- Geographical variations exist, with higher procedural rates observed in the U.S.
Abstract:
The degree to which catheterization and revascularization procedures are utilized in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) during hospitalization has broad implications with respect to initial pharmacotherapeutic decisions (upfront therapies), treatment and hospital transfer protocols, guideline recommendations, and allocation of training, material, and financial resources. Analysis of data from multiple trials and registries of patients with NSTE-ACS has the potential to assess more broadly utilization of invasive and revascularization procedures and provide a wide angle or bird's-eye view of the management of such patients, complementing the data obtained from any one trial or registry. We therefore undertook a systematic overview of all large trials and registries of patients with NSTE-ACS conducted over the last decade that were deemed appropriate to provide information on catheterization and revascularization procedures. Although not unexpectedly the percentage of patients with NSTE-ACS managed with cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting varies in different clinical trials and registries, general findings and trends were still discernable from these studies. During the initial treatment period, the majority of patients were ultimately treated with medical therapy alone (e.g., without revascularization). The percentage of those NSTE-ACS patients undergoing diagnostic cardiac catheterization who were then managed with PCI increased over the last decade and now stands at approximately 50%. Of NSTE-ACS patients who undergo revascularization, the percentage of those patients who are revascularized via PCI similarly increased, and PCI is currently the revascularization procedure utilized in approximately three-fourths of patients undergoing revascularization. The percentages of patients undergoing invasive and revascularization procedures were consistently higher in the U.S. cohorts of study subjects when compared to non-U.S. cohorts of study subjects.
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