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Practice patterns and clinical outcomes among non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) patients presenting to primary and tertiary hospitals: Insights from the EARLY glycoprotein IIb/IIIa inhibition in NSTE‐ACS (EARLY‐ACS) trial
Author(s) -
Toleva Olga,
Westerhout Cynthia M.,
Senaratne Manohara P.J.,
Bode Christoph,
Lindroos Magnus,
Sulimov Vitaly A.,
Montalescot Gilles,
Newby L. Kristin,
Giugliano Robert P.,
Werf Frans,
Armstrong Paul W.
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25590
Subject(s) - medicine , acute coronary syndrome , st segment , cardiology , st elevation , electrocardiography , myocardial infarction
Objectives We evaluated patients at tertiary [both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) capable] and primary hospitals in the EARLY‐ACS trial. Background Early invasive management is recommended for high‐risk non‐ST‐segment elevation acute coronary syndromes. Methods We evaluated outcomes in 9,204 patients presenting to: tertiary sites, primary sites with transfer to tertiary sites (“transferred”) and those who remained at primary sites (“non‐transfer”). Results There were 348 tertiary ( n = 7,455 patients) and 89 primary hospitals [ n = 1,749 patients (729 transferred; 1,020 non‐transfer)]. Significant delays occurred in time from symptom onset to angiography (49 hr), PCI (53h), and CABG (178 hr) for transferred patients ( P < 0.001). Non‐transfer patients had less 30‐day death/myocardial infarction [9.4% vs. 11.7% (tertiary); adjusted odds ratio (OR): 0.78 (0.62–0.97), P = 0.026]; transferred (14.0%) and tertiary patients were similar [adjusted OR: 1.23 (0.98–1.53), P = 0.074]. Non‐transfer patients had lower 1‐year mortality [4.3% vs. 6.3% (tertiary); adjusted hazard ratio (HR): 0.64 (0.47–0.87), P = 0.005]: there was no difference between transferred and tertiary patients [5.2% vs. 6.3%; adjusted HR: 0.80 (0.58–1.12), P = 0.202]. Despite similar rates of catheterization, GUSTO severe/moderate bleeding within 120 hr was less in non‐transfer [3.1% vs. 6.7% (tertiary); adjusted OR: 0.47 (0.32–0.68), P < 0.001], whereas transferred (6.1%) and tertiary patients were similar [adjusted OR: 0.94 (0.68–1.30), P = 0.693]. There was no difference in non‐CABG bleeding. Conclusions Timely angiography and revascularization were often not achieved in transferred patients. Non‐transferred patients presenting to primary sites had the lowest event rates and the best long‐term survival. © 2014 Wiley Periodicals, Inc.