Relation Between Institution Volume of Percutaneous Coronary Interventions and Management Strategy in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome (On Behalf of ACCORD-Taiwan Study Investigators).
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
T. Lin, W. Lai
Background: Early invasive strategy (EIS) is beneficial for high-risk patients suffering from non¨CST-segment elevation acute coronary syndrome (NSTEACS). Previous studies found patients having better prognosis after percutaneous coronary interventions (PCI) at high-volume institutions (HVI) compared with low-volume institutions (LVI). However, there is limited report discussing this relationship in patients with NSTEACS.
Methods: Total of 1213 NSTEACS patients enrolled in the ACute CORonary Syndrome Descriptive Taiwan study (ACCORD-Taiwan) were evaluated. Clinical presentations, management strategies as well as 1-year clinic visits between HVI and LVI were compared. HVI is defined as those institutions with more than 400 PCI numbers per year; while EIS is defined as the time between admissions to catheterization in less than 48 hours.
Results: Compared with patients who visited LVI (n = 300), patients in the HVI (n = 913) had longer time between symptom onset to admission, less history of angina, less typical chest pain and ST-depression, but had higher percentage of using clopidogrel loading, b-blockers and angiotensin converting enzyme inhibitors during admission. Patients in the HVI receiving EIS were generally younger, male, had more history of myocardial infarction, PCI and hypercholesterolemia, typical chest pain, and a higher percentage of used clopidogrel loading during admission. In the LVI, EIS is being applied more frequently in patients with more history of unstable angina and family cardiovascular events. For patients receiving PCI during admission, there was higher percentage of EIS in the HVI. Compared with patients receiving early conservative strategy, those receiving EIS had higher rates of regular clinic visits at 3, 6, 9 and 12 months¡¯ follow-up in the HVI but these differences were not significant in the LVI.
Conclusion: Despite late presentation, patients at the HVI received better guideline-recommended management and aggressive treatment, which is associated with higher number of clinic visits after discharge and may possibly leads to better prognosis.
