Regional outcomes after admission for high-risk non-ST-segment elevation acute coronary syndromes.

Journal Article (Journal Article)

PURPOSE: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed. SUBJECTS AND METHODS: We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (<24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated. RESULTS: Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case-fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast. CONCLUSIONS: Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case-fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables.

Full Text

Duke Authors

Cited Authors

  • Menon, V; Rumsfeld, JS; Roe, MT; Cohen, MG; Peterson, ED; Brindis, RG; Chen, AY; Pollack, CV; Smith, SC; Gibler, WB; Ohman, EM

Published Date

  • July 2006

Published In

Volume / Issue

  • 119 / 7

Start / End Page

  • 584 - 590

PubMed ID

  • 16828630

Pubmed Central ID

  • 16828630

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2006.01.018


  • eng

Conference Location

  • United States