Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events

Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)); Gabor T Gyenes; Andrew T Yan; Mary Tan; Robert C Welsh; Keith A A Fox; Francois R Grondin; J Paul Deyoung; Barry F Rose; Richard Gallo; Jan M Kornder; Graham C Wong; Shaun G Goodman

doi:10.1016/j.cjca.2013.04.035

Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events

Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)), Gabor T Gyenes, Andrew T Yan, Mary Tan, Robert C Welsh, Keith A A Fox, Francois R Grondin, J Paul Deyoung, Barry F Rose, Richard Gallo, Jan M Kornder, Graham C Wong, Shaun G Goodman

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: Although an early invasive approach has become standard strategy for the management of non-ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain.

METHODS: We examined the use and timing of coronary angiography, revascularization, and cardiovascular outcomes of NSTEMI patients: (1) admitted on weekdays vs weekends; and (2) stratified according to presentation risk level, in the Canadian Global Registry of Acute Coronary Events (GRACE)/Expanded GRACE (GRACE(2))/Canadian Registry of Acute Coronary Events (CANRACE) population.

RESULTS: Of 6711 NSTEMI patients, 1956 (29.1%) were admitted on the weekend. The median (interquartile range) wait time for coronary angiography was 58 (32-106) and 70 (50-112) hours for weekday and weekend patients, respectively (P = 0.32). Compared with lower-intermediate risk, higher-risk patients were less likely to undergo angiography (44.7% vs 69.7% for weekdays and 45.2% vs 69.6% for weekends; both P < 0.0001) and waited longer for angiography (median 71 vs 61 hours; P < 0.0001). Weekend admission was independently associated with higher mortality (adjusted odds ratio [OR], 1.52; 95% confidence interval [CI], 1.15-2.01; P = 0.004), recurrent ischemia (adjusted OR, 1.16; 95% CI, 1.01-1.32; P = 0.03), and heart failure (adjusted OR, 1.28; 95% CI, 1.00-1.63; P = 0.048) but not with reinfarction.

CONCLUSIONS: Median wait time for angiography in Canadian NSTEMI patients admitted on the weekend was not significantly longer than for those who presented on a weekday. Patients admitted on weekends had higher adjusted mortality and cardiovascular event rates. Higher-risk patients were less likely to undergo angiography and waited longer, with higher observed in-hospital event rates. Systematic, guideline-recommended risk stratification should be considered to ensure that optimal management strategies (eg, timely coronary angiography in higher-risk patients) are matched to level of risk.

Original language	English
Pages (from-to)	1429-35
Number of pages	7
Journal	Canadian journal of cardiology
Volume	29
Issue number	11
DOIs	https://doi.org/10.1016/j.cjca.2013.04.035
Publication status	Published - Nov 2013

Keywords / Materials (for Non-textual outputs)

Aged
Canada
Cardiac Catheterization
Coronary Angiography
Female
Heart Failure
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Myocardial Ischemia
Myocardial Revascularization
Patient Admission
Registries
Retrospective Studies
Risk Assessment
Time Factors

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Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)), Gyenes, G. T., Yan, A. T., Tan, M., Welsh, R. C., Fox, K. A. A., Grondin, F. R., Deyoung, J. P., Rose, B. F., Gallo, R., Kornder, J. M., Wong, G. C., & Goodman, S. G. (2013). Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events. Canadian journal of cardiology, 29(11), 1429-35. https://doi.org/10.1016/j.cjca.2013.04.035

Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)) ; Gyenes, Gabor T ; Yan, Andrew T et al. / Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients : insights from the Canadian Global Registry of Acute Coronary Events. In: Canadian journal of cardiology. 2013 ; Vol. 29, No. 11. pp. 1429-35.

@article{d4723b25305541f18b8e52d32ab07a7e,

title = "Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events",

abstract = "BACKGROUND: Although an early invasive approach has become standard strategy for the management of non-ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain.METHODS: We examined the use and timing of coronary angiography, revascularization, and cardiovascular outcomes of NSTEMI patients: (1) admitted on weekdays vs weekends; and (2) stratified according to presentation risk level, in the Canadian Global Registry of Acute Coronary Events (GRACE)/Expanded GRACE (GRACE(2))/Canadian Registry of Acute Coronary Events (CANRACE) population.RESULTS: Of 6711 NSTEMI patients, 1956 (29.1%) were admitted on the weekend. The median (interquartile range) wait time for coronary angiography was 58 (32-106) and 70 (50-112) hours for weekday and weekend patients, respectively (P = 0.32). Compared with lower-intermediate risk, higher-risk patients were less likely to undergo angiography (44.7% vs 69.7% for weekdays and 45.2% vs 69.6% for weekends; both P < 0.0001) and waited longer for angiography (median 71 vs 61 hours; P < 0.0001). Weekend admission was independently associated with higher mortality (adjusted odds ratio [OR], 1.52; 95% confidence interval [CI], 1.15-2.01; P = 0.004), recurrent ischemia (adjusted OR, 1.16; 95% CI, 1.01-1.32; P = 0.03), and heart failure (adjusted OR, 1.28; 95% CI, 1.00-1.63; P = 0.048) but not with reinfarction.CONCLUSIONS: Median wait time for angiography in Canadian NSTEMI patients admitted on the weekend was not significantly longer than for those who presented on a weekday. Patients admitted on weekends had higher adjusted mortality and cardiovascular event rates. Higher-risk patients were less likely to undergo angiography and waited longer, with higher observed in-hospital event rates. Systematic, guideline-recommended risk stratification should be considered to ensure that optimal management strategies (eg, timely coronary angiography in higher-risk patients) are matched to level of risk.",

keywords = "Aged, Canada, Cardiac Catheterization, Coronary Angiography, Female, Heart Failure, Hospital Mortality, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Patient Admission, Registries, Retrospective Studies, Risk Assessment, Time Factors",

author = "{Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2))} and Gyenes, {Gabor T} and Yan, {Andrew T} and Mary Tan and Welsh, {Robert C} and Fox, {Keith A A} and Grondin, {Francois R} and Deyoung, {J Paul} and Rose, {Barry F} and Richard Gallo and Kornder, {Jan M} and Wong, {Graham C} and Goodman, {Shaun G}",

year = "2013",

month = nov,

doi = "10.1016/j.cjca.2013.04.035",

language = "English",

volume = "29",

pages = "1429--35",

journal = "Canadian journal of cardiology",

issn = "1916-7075",

publisher = "Pulsus Group Inc.",

number = "11",

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Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)), Gyenes, GT, Yan, AT, Tan, M, Welsh, RC, Fox, KAA, Grondin, FR, Deyoung, JP, Rose, BF, Gallo, R, Kornder, JM, Wong, GC & Goodman, SG 2013, 'Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events', Canadian journal of cardiology, vol. 29, no. 11, pp. 1429-35. https://doi.org/10.1016/j.cjca.2013.04.035

Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events. / Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)); Gyenes, Gabor T; Yan, Andrew T et al.
In: Canadian journal of cardiology, Vol. 29, No. 11, 11.2013, p. 1429-35.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients

T2 - insights from the Canadian Global Registry of Acute Coronary Events

AU - Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2))

AU - Gyenes, Gabor T

AU - Yan, Andrew T

AU - Tan, Mary

AU - Welsh, Robert C

AU - Fox, Keith A A

AU - Grondin, Francois R

AU - Deyoung, J Paul

AU - Rose, Barry F

AU - Gallo, Richard

AU - Kornder, Jan M

AU - Wong, Graham C

AU - Goodman, Shaun G

PY - 2013/11

Y1 - 2013/11

N2 - BACKGROUND: Although an early invasive approach has become standard strategy for the management of non-ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain.METHODS: We examined the use and timing of coronary angiography, revascularization, and cardiovascular outcomes of NSTEMI patients: (1) admitted on weekdays vs weekends; and (2) stratified according to presentation risk level, in the Canadian Global Registry of Acute Coronary Events (GRACE)/Expanded GRACE (GRACE(2))/Canadian Registry of Acute Coronary Events (CANRACE) population.RESULTS: Of 6711 NSTEMI patients, 1956 (29.1%) were admitted on the weekend. The median (interquartile range) wait time for coronary angiography was 58 (32-106) and 70 (50-112) hours for weekday and weekend patients, respectively (P = 0.32). Compared with lower-intermediate risk, higher-risk patients were less likely to undergo angiography (44.7% vs 69.7% for weekdays and 45.2% vs 69.6% for weekends; both P < 0.0001) and waited longer for angiography (median 71 vs 61 hours; P < 0.0001). Weekend admission was independently associated with higher mortality (adjusted odds ratio [OR], 1.52; 95% confidence interval [CI], 1.15-2.01; P = 0.004), recurrent ischemia (adjusted OR, 1.16; 95% CI, 1.01-1.32; P = 0.03), and heart failure (adjusted OR, 1.28; 95% CI, 1.00-1.63; P = 0.048) but not with reinfarction.CONCLUSIONS: Median wait time for angiography in Canadian NSTEMI patients admitted on the weekend was not significantly longer than for those who presented on a weekday. Patients admitted on weekends had higher adjusted mortality and cardiovascular event rates. Higher-risk patients were less likely to undergo angiography and waited longer, with higher observed in-hospital event rates. Systematic, guideline-recommended risk stratification should be considered to ensure that optimal management strategies (eg, timely coronary angiography in higher-risk patients) are matched to level of risk.

AB - BACKGROUND: Although an early invasive approach has become standard strategy for the management of non-ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain.METHODS: We examined the use and timing of coronary angiography, revascularization, and cardiovascular outcomes of NSTEMI patients: (1) admitted on weekdays vs weekends; and (2) stratified according to presentation risk level, in the Canadian Global Registry of Acute Coronary Events (GRACE)/Expanded GRACE (GRACE(2))/Canadian Registry of Acute Coronary Events (CANRACE) population.RESULTS: Of 6711 NSTEMI patients, 1956 (29.1%) were admitted on the weekend. The median (interquartile range) wait time for coronary angiography was 58 (32-106) and 70 (50-112) hours for weekday and weekend patients, respectively (P = 0.32). Compared with lower-intermediate risk, higher-risk patients were less likely to undergo angiography (44.7% vs 69.7% for weekdays and 45.2% vs 69.6% for weekends; both P < 0.0001) and waited longer for angiography (median 71 vs 61 hours; P < 0.0001). Weekend admission was independently associated with higher mortality (adjusted odds ratio [OR], 1.52; 95% confidence interval [CI], 1.15-2.01; P = 0.004), recurrent ischemia (adjusted OR, 1.16; 95% CI, 1.01-1.32; P = 0.03), and heart failure (adjusted OR, 1.28; 95% CI, 1.00-1.63; P = 0.048) but not with reinfarction.CONCLUSIONS: Median wait time for angiography in Canadian NSTEMI patients admitted on the weekend was not significantly longer than for those who presented on a weekday. Patients admitted on weekends had higher adjusted mortality and cardiovascular event rates. Higher-risk patients were less likely to undergo angiography and waited longer, with higher observed in-hospital event rates. Systematic, guideline-recommended risk stratification should be considered to ensure that optimal management strategies (eg, timely coronary angiography in higher-risk patients) are matched to level of risk.

KW - Aged

KW - Canada

KW - Cardiac Catheterization

KW - Coronary Angiography

KW - Female

KW - Heart Failure

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Myocardial Ischemia

KW - Myocardial Revascularization

KW - Patient Admission

KW - Registries

KW - Retrospective Studies

KW - Risk Assessment

KW - Time Factors

U2 - 10.1016/j.cjca.2013.04.035

DO - 10.1016/j.cjca.2013.04.035

M3 - Article

C2 - 23910228

SN - 1916-7075

VL - 29

SP - 1429

EP - 1435

JO - Canadian journal of cardiology

JF - Canadian journal of cardiology

IS - 11

ER -

Canadian Global Registry of Acute Coronary Events (GRACE/GRACE(2)), Gyenes GT, Yan AT, Tan M, Welsh RC, Fox KAA et al. Use and timing of coronary angiography and associated in-hospital outcomes in Canadian non-ST-segment elevation myocardial infarction patients: insights from the Canadian Global Registry of Acute Coronary Events. Canadian journal of cardiology. 2013 Nov;29(11):1429-35. doi: 10.1016/j.cjca.2013.04.035