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Determinants and outcomes of coronary angiography after non-ST-segment elevation myocardial infarction. A cohort study of the Myocardial Ischaemia National Audit Project (MINAP)
Heart, Volume: 95, Issue: 19, Pages: 1593 - 1599
Swansea University Author: Clive Weston
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Using an observational study design we investigated determinants of, and outcomes from, coronary angiography and intervention in 13,489 admissions to 44 British hospitals with non-ST-segment elevation myocardial infarction (NSTEMI) between July 2005 to December 2006.Significantly lower rates of angi...
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Using an observational study design we investigated determinants of, and outcomes from, coronary angiography and intervention in 13,489 admissions to 44 British hospitals with non-ST-segment elevation myocardial infarction (NSTEMI) between July 2005 to December 2006.Significantly lower rates of angiography were seen for women, the elderly, the most deprived and those having cardiac, and most non-cardiac, comorbidities. Performance of angiography, compared with no angiography, was not associated with lower rate of readmission (multiple adjusted hazard ratio (HR) = 0.96, 95% CI 0.74 to 1.24) unless accompanied by coronary intervention (HR = 0.73, 95% CI 0.56 to 0.95). Angiography was associated with reduction in 180-day mortality for survivors of hospitalisation (HR = 0.59, 95% CI 0.49 to 0.72); with greater reduction when followed by an intervention (HR = 0.34, 95% CI 0.28 to 0.42). This mortality benefit after intervention was seen both in women (HR = 0.42, 95% CI 0.29 to 0.60) and men (HR = 0.31, 95% CI 0.24 to 0.41), and across age groups: <65 years (HR = 0.25, 95% CI 0.14 to 0.44), 65-79 years (HR = 0.29, 95% CI 0.22 to 0.39) and > or =80 years (HR = 0.52, 95% CI 0.37 to 0.74). Mortality benefit was not significantly attenuated by the presence of comorbidities.Performance of angiography and coronary intervention after NSTEMI was associated with mortality benefit that persisted in the presence of both cardiac and non-cardiac comorbidities. Mortality benefit was seen across age groups and was similar for both sexes.
Acute coronary syndrome;
Swansea University Medical School