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Variation in treatment strategy for non-ST segment elevation myocardial infarction: A multilevel methodological approach

Authors
 Yoon Jung Park  ;  Jang Hoon Lee  ;  Hyeon Jeong Kim  ;  Bo Eun Park  ;  Hong Nyun Kim  ;  Se Yong Jang  ;  Myung Hwan Bae  ;  Dong Heon Yang  ;  Hun Sik Park  ;  Yongkeun Cho  ;  Myung Ho Jeong  ;  Jong-Seon Park  ;  Hyo-Soo Kim  ;  Seung-Ho Hur  ;  In-Whan Seong  ;  Myeong-Chan Cho  ;  Chong-Jin Kim  ;  Shung Chull Chae 
Citation
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.328 : 35-39, 2021-04 
Journal Title
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN
 0167-5273 
Issue Date
2021-04
MeSH
Coronary Angiography ; Coronary Artery Disease* ; Hospital Mortality ; Humans ; Male ; Myocardial Infarction* / diagnosis ; Myocardial Infarction* / epidemiology ; Myocardial Infarction* / therapy ; Non-ST Elevated Myocardial Infarction* / diagnostic imaging ; Non-ST Elevated Myocardial Infarction* / epidemiology ; Registries ; Risk Factors ; ST Elevation Myocardial Infarction* ; Treatment Outcome
Keywords
Acute myocardial infarction ; Treatment strategy ; Variation
Abstract
Background: Variations by hospital and region in the selection of an early invasive strategy (EIS) after non-ST-segment elevation myocardial infarction (NSTEMI) in patients with high-risk criteria are unknown.

Methods: We evaluated the data of 7037 patients with NSTEMI from 20 hospitals of 3 regions from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. We used hierarchical generalized linear mixed-models to estimate region- and hospital-level variation in the selection of an EIS after adjusting for patient-level high-risk criteria. We explored the variation using the median rate ratio (MRR), which estimates the relative difference in the risk ratios of two hypothetically identical patients at two different sites.

Results: An EIS was selected in 84.4% of patients. At the hospital level, the median selection rate was 80.4%. At the region level, the median selection rate was 74.9% in the east region, 81.3% in the north region, and 83.9% in the west region, respectively. After adjusting for patient-level covariates, we found significant hospital- (MRR 2.19, 95% confidence interval [CI]: 1.74-3.03) and region-level (MRR 1.88, 95%CI: 1.26-5.44) variation in the selection of an EIS. Among patient-level factors, male sex, ongoing chest pain, history of coronary artery disease or acute heart failure, and GRACE risk score > 140 were independently associated with the selection of an EIS.

Conclusions: We observed significant hospital- and region-level variation in the selection of an EIS after NSTEMI in high-risk patients. Quality improvement efforts are required to standardize decision making and to improve clinical outcomes.
Full Text
https://www.sciencedirect.com/science/article/pii/S0167527320342285
DOI
10.1016/j.ijcard.2020.11.059
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190983
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