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Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease.

Publication ,  Journal Article
Harskamp, RE; Wang, TY; Bhatt, DL; Wiviott, SD; Amsterdam, EA; Li, S; Thomas, L; de Winter, RJ; Roe, MT
Published in: Am Heart J
March 2014

BACKGROUND: Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. METHODS: We evaluated patterns of use and patient features across United States hospitals designated by MMS for NSTEMI patients with 3VD/LMD included in the ACTION Registry-GWTG from 2007-2012. RESULTS: A total of 42,535 patients without prior bypass surgery were found to have 3VD (≥50% stenosis in all major coronary vessels) or LMD (≥50% lesion) during in-hospital angiography at 423 hospitals with percutaneous and surgical revascularization capabilities. Hospitals (n = 316) with an adequate volume (≥25 NSTEMI patients treated) were stratified into tertiles defined by use of MMS; differences in patient characteristics and outcomes were analyzed. The proportion of NSTEMI patients treated with MMS at all hospitals varied from 16% to 19% each quarter and did not change significantly from 2007 to 2012 (P trend = .11). Among hospitals with adequate volume, the proportion of patients treated with MMS also varied widely (median 17.1%, range: 0.0-44.8%, P < .0001). Patient baseline characteristics, predicted mortality risk, actual in-hospital mortality rates, and discharge treatments were similar across hospital tertiles. CONCLUSIONS: Close to 20% of patients with NSTEMI and 3VD/LMD identified during in-hospital angiography are treated with MMS without revascularization in contemporary practice. Since the use of MMS varies widely across hospitals despite a relatively similar hospital-level case mix, these findings suggest that there is no standard threshold for the use of revascularization in NSTEMI patients with 3VD/LMD.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2014

Volume

167

Issue

3

Start / End Page

355 / 362.e3

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Practice Patterns, Physicians'
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitals
 

Citation

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Harskamp, R. E., Wang, T. Y., Bhatt, D. L., Wiviott, S. D., Amsterdam, E. A., Li, S., … Roe, M. T. (2014). Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease. Am Heart J, 167(3), 355-362.e3. https://doi.org/10.1016/j.ahj.2013.12.004
Harskamp, Ralf E., Tracy Y. Wang, Deepak L. Bhatt, Stephen D. Wiviott, Ezra A. Amsterdam, Shuang Li, Laine Thomas, Robbert J. de Winter, and Matthew T. Roe. “Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease.Am Heart J 167, no. 3 (March 2014): 355-362.e3. https://doi.org/10.1016/j.ahj.2013.12.004.
Harskamp RE, Wang TY, Bhatt DL, Wiviott SD, Amsterdam EA, Li S, et al. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease. Am Heart J. 2014 Mar;167(3):355-362.e3.
Harskamp, Ralf E., et al. “Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease.Am Heart J, vol. 167, no. 3, Mar. 2014, pp. 355-362.e3. Pubmed, doi:10.1016/j.ahj.2013.12.004.
Harskamp RE, Wang TY, Bhatt DL, Wiviott SD, Amsterdam EA, Li S, Thomas L, de Winter RJ, Roe MT. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease. Am Heart J. 2014 Mar;167(3):355-362.e3.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2014

Volume

167

Issue

3

Start / End Page

355 / 362.e3

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Practice Patterns, Physicians'
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitals