尽管美国各医院对非ST段抬高型心肌梗死(NSTEMI)患者的管理存在差异,很少有数据描述特定管理策略后结果的变化。
■NSTEMI医院接受冠状动脉造影检查,经皮冠状动脉介入治疗(PCI),从国家住院患者样本中确定了2016年至2018年之间的冠状动脉旁路移植术(CABG)手术。根据所提供的治疗对患者进行分类(仅药物治疗,没有血管重建的血管造影,PCI或CABG)。主要终点是复合院内死亡发生率的差异,术后心肌梗死,或中风,按治疗分层。次要结果包括住院时间(LOS)的变化,成本,以及每种治疗方式的使用。变异的特征在于中位数比值比。
■在140,194例NSTEMI住院患者中,35,748名(25.5%)患者仅接受药物治疗,28,678(20.5%)接受了血管造影,但未进行血运重建,58,383(41.6%)行PCI,17,385(12.4%)行CABG。尽管根据患者和医院相关因素进行了调整,在随机选择的一家医院中,2名相似的患者在PCI后经历复合主要结局的可能性高25%,在CABG后经历复合主要结局的可能性高45%。在每种治疗方式之后,LOS和成本的医院级别差异也很明显。
■在对NSTEMI住院的大型国家分析中,在临床结果中观察到显著的变化,LOS,以及与每种治疗方式相关的成本,尽管对患者和医院相关因素进行了调整。
UNASSIGNED: Although
variation in the management of patients with non-ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing
variation in outcomes following specific management strategies.
UNASSIGNED: Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included
variation in length of stay (LOS), cost, and use of each treatment modality.
Variation was characterized by the median odds ratio.
UNASSIGNED: Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality.
UNASSIGNED: In a large national analysis of hospitalizations for NSTEMI, significant
variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors.