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Comparative Profiles and Invasive Management of Patients With High-Risk Non-ST Elevation Acute Coronary Syndromes in
Alexandru-George Cotoban1,2, Amir A Mahabadi3, Tienush Rassaf3
1Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Insights
Patients with high-risk non-ST elevation acute coronary syndromes (NSTE-ACS) in Romania presented with a worse cardiovascular disease risk profile at a younger age compared to Germany. Healthcare system organization significantly impacted invasive coronary angiography timing in Romania, unlike in Germany where patient characteristics were more influential.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Regional variations in cardiovascular disease (CVD) prevalence and outcomes exist across Europe.
- European Society of Cardiology guidelines advocate for invasive coronary angiography (ICA) within 24 hours for high-risk non-ST elevation acute coronary syndromes (NSTE-ACS).
- Management of NSTE-ACS remains inconsistent throughout Europe.
Purpose of the Study:
- To compare patient profiles of high-risk NSTE-ACS between two European university hospitals.
- To identify factors associated with the timing of ICA in relation to the recommended 24-hour interval.
- To explore differences in a Romanian hospital (higher CVD prevalence, lower income) and a German hospital (lower CVD prevalence, higher income).
Main Methods:
- Retrospective, observational, all-comers study design.
- Analysis of consecutive invasively managed patients with high-risk NSTE-ACS in 2022.
- Comparison of clinical profiles and factors influencing ICA timing between Bucharest, Romania, and Essen, Germany.
Main Results:
- A total of 587 patients were included (301 RO, 286 GER).
- Romanian patients were younger and had higher rates of obesity, hypertension, dyslipidemia, diabetes, and smoking.
- German patients had higher rates of prior myocardial revascularization, chronic respiratory disease, sleep apnea, thyroid disorders, and neoplasia.
- ICA within 24 hours was performed in 68.1% of Romanian patients versus 74.8% of German patients (P=0.006).
- Factors associated with timely ICA differed: transfers and on-hours admission in Romania; myocardial infarction diagnosis and typical angina in Germany.
Conclusions:
- Patient profiles for high-risk NSTE-ACS reflect regional CVD patterns.
- Romanian patients exhibited a worse CVD risk factor profile at a younger age, with potentially underdiagnosed comorbidities.
- Healthcare system organization and hospital logistics significantly influenced ICA timing in Romania, contrasting with patient characteristics in Germany.
Background:
Regional differences in cardiovascular disease (CVD), prevalence, and outcomes in the European population have been reported. Although current European Society of Cardiology guidelines recommend invasive coronary angiography (ICA) <24 hours from diagnosis in high-risk non-ST elevation acute coronary syndromes (NSTE-ACS), overall management remains heterogenous across Europe.
Study Question:
What are the differences regarding profiles of patients with high-risk NSTE-ACS and factors associated with timing of ICA in 2 university hospitals from 2 European countries with different prevalence of CVD and different income (University and Emergency Hospital, Bucharest, Romania [RO] and University Hospital, Essen, Germany [GER])?
Study Design:
Retrospective, observational, all-comers.
Measures And Outcomes:
All consecutive invasively managed patients with high-risk NSTE-ACS in 2022 were retrospectively identified and analyzed regarding clinical profiles and factors associated with ICA timing in relation to the 24-hour European Society of Cardiology recommended interval.
Results:
A total of 587 patients were included: 301 from RO and 286 from GER. RO patients were younger (64.6 vs. 70.6 years, P < 0.001), with higher rates of obesity (P = 0.013), hypertension (P = 0.001), dyslipidemia (P < 0.001), diabetes (P < 0.001), and active smoking (P = 0.019), whereas GER patients had higher rates of previous myocardial revascularization (P < 0.001), chronic respiratory disease (P < 0.001), sleep apnea (P < 0.001), thyroid disorders (P < 0.001), and neoplasia (P = 0.036). About 68.1% patients from RO versus 74.8% from GER underwent ICA <24 hours (P = 0.006). Transfers and admission during cathlab on-hours in RO, diagnosis of myocardial infarction, and typical angina in GER were associated with ICA <24 hours (all P < 0.05).
Conclusions:
High-risk NSTE-ACS patient profiles mirrored overall regional CVD patterns. Compared to the German hospital, patients in the Romanian hospital had a worse CVD risk factor profile at a younger age, lower previous myocardial revascularization, and potentially underdiagnosed comorbidities. Health care system organization and hospital logistics largely influenced ICA timing in the Romanian hospital, opposite mainly patient characteristics in the German hospital.
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