EARLY INVASIVE STRATEGY CONVEYS SIGNIFICANT SURVIVAL BENEFIT AMONG HIGHER-RISK NON-ST ELEVATION ACUTE CORONARY SYNDROME (NSTEACS) PATIENTS

OBJECTIVES: Early invasive strategy is the current guidelines recommended management of higher-risk NSTEACS patients based on reduced long-term mortality reported in clinical trials. We evaluated the association of receiving early cardiac catheterization (within 48 hours since admission) with one-year mortality in real-world NSTEACS patient population.

METHODS: This is a retrospective cohort study of NSTEACS patients with first hospitalization for an event between 2003 and 2013 using data from the Cardiovascular Health Nova Scotia registry. Multivariate logistic regression models were fit to analyze the association between patient characteristics and receiving catheterization. As the guidelines recommend using risk algorithms for optimal risk stratification, the patients were risk stratified using the Nova Scotia NSTEACS Long Term Mortality Risk Score to analyze the association between each risk category and receiving the procedure, and one-year mortality (adjusting for gender, place of residence, type of hospital, and guideline period).

RESULTS: The study included 25 463 NSTEACS patients, those who received and who did not receive cardiac catheterization at any time during hospitalization. Older age (>75 years) or prior comorbidities such as congestive heart failure, stroke, and renal insufficiency were significantly associated with decreased odds of receiving early cardiac catheterization. When stratified by risk, adjusted models indicated that higher-risk groups were significantly less likely to receive early catheterization compared to low-risk patients (OR high-risk 0.41, p<0.0001; OR very high-risk 0.14, p<0.0001). One-year mortality risk in those who received the procedure was significantly reduced (OR high risk 0.33, p<0.0001; OR very high risk 0.32, p<0.0001).

CONCLUSIONS: This real-world study shows that higher-risk NSTEASC patients had significantly reduced risk of one-year mortality when received early cardiac catheterization, although they were significantly less likely to receive the procedure compared to their lower-risk counterparts. Regular monitoring of the proportion of higher-risk patients receiving cardiac catheterization, and reporting results to involved stakeholders may improve patient outcomes.