Factors that influence whether patients with acute coronary syndromes undergo cardiac catheterisation
Michael Ayad1, Karice Hyun2,3, Mario D'Souza2
1The University of Sydney, Sydney, NSW.
Insights
Patients with acute coronary syndrome (ACS) presenting to hospitals with catheterisation facilities had higher rates of cardiac procedures. However, outcomes were similar, indicating equitable ACS management across Australia.
Area of Science:
- Cardiology
- Public Health
Background:
- Acute coronary syndrome (ACS) management varies based on hospital resources.
- Assessing the impact of catheterisation availability on ACS patient care is crucial.
Purpose of the Study:
- To investigate if hospital availability of invasive coronary angiography influences catheterisation rates in ACS patients.
- To determine if presenting to a catheterisation-capable hospital improves outcomes for ACS patients.
Main Methods:
- Retrospective cohort study using the Cooperative National Registry of Acute Coronary Events (CONCORDANCE) data.
- Analysis of adult ACS admissions across 43 Australian hospitals from February 2009 to October 2018.
Main Results:
- Patients presenting to catheterisation-capable hospitals had higher rates of catheterisation (81% vs. 70%) and percutaneous coronary intervention (49% vs. 35%).
- Despite differences in procedure rates, baseline patient characteristics selected for catheterisation were similar across hospital types.
- In-hospital and follow-up rates of major adverse cardiovascular events and all-cause death were comparable between the two groups.
Conclusions:
- While catheterisation-capable hospitals perform more procedures, patient selection is equitable.
- Outcomes for acute coronary syndrome patients are similar regardless of presentation hospital's catheterisation capability, suggesting equitable care across Australia.
Objective:
To determine whether the availability of invasive coronary angiography at the hospital of presentation influences catheterisation rates for patients with acute coronary syndrome (ACS), and whether presenting to a catheterisation-capable hospital is associated with better outcomes for patients with ACS.
Design, Setting:
Retrospective cohort study; analysis of Cooperative National Registry of Acute Coronary Events (CONCORDANCE) data.
Setting, Participants:
Adults admitted with ACS to 43 Australian hospitals (including 31 catheterisation-capable hospitals), February 2009 - October 2018.
Main Outcome Measures:
Major adverse cardiovascular events (myocardial infarction, stroke, congestive heart failure, cardiogenic shock, cardiovascular death) and all-cause deaths in hospital and by six and 12- or 24-month follow-up.
Results:
The proportion of women among the 5637 patients who presented to catheterisation-capable hospitals was smaller than for the 2608 patients who presented to hospitals without catheterisation facilities (28% v 33%); the proportion of patients diagnosed with ST elevation myocardial infarction was larger (32% v 20%). The proportions of patients who underwent catheterisation (81% v 70%) or percutaneous coronary intervention (49% v 35%) were larger for those who presented to catheterisation-capable hospitals. The baseline characteristics of patients who underwent catheterisation were similar for both presentation hospital categories, as were rates of major adverse cardiovascular events and all-cause death in hospital and by 6- and 12- or 24-month follow-up.
Conclusions:
Although a larger proportion of patients who presented to catheterisation-capable hospitals underwent catheterisation, patients with similar characteristics were selected for the procedure, independent of the hospital of presentation. Major outcomes for patients were also similar, suggesting equitable management of patients with ACS across Australia.
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