Article Text

PDF
Coronary artery disease
Determinants and outcomes of coronary angiography after non-ST-segment elevation myocardial infarction. A cohort study of the Myocardial Ischaemia National Audit Project (MINAP)
  1. J S Birkhead1,
  2. C F M Weston2,
  3. R Chen3
  1. 1
    National Institute for Clinical Outcomes Research, The Heart Hospital, London, UK
  2. 2
    The School of Medicine, Swansea University, Singleton Park, Swansea, UK
  3. 3
    University College London Medical School, London, UK
  1. Correspondence to Dr C F M Weston. The School of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK; c.f.m.weston{at}swansea.ac.uk

Abstract

Objective: To investigate determinants of, and outcomes from, coronary angiography and intervention in patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Design: Observational study.

Setting: 44 British hospitals with interventional facilities.

Patients: 13 489 admissions with NSTEMI; July 2005 to December 2006.

Main outcome measures: Rate of angiography during index admission; death and readmission to hospital within 180 days.

Results: 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 ⩾80 years (HR = 0.52, 95% CI 0.37 to 0.74). Mortality benefit was not significantly attenuated by the presence of comorbidities.

Conclusion: 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.

Statistics from Altmetric.com

Footnotes

  • Funding MINAP is funded by the Healthcare Quality Improvement Partnership.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.