title: [Factors associated with early invasive strategy in patients with acute coronary syndrome. A multicenter study].
abstract: OBJECTIVE
  To identify the factors associated with early cardiac catheterization in patients with a non ST-segment elevation acute coronary syndrome.
  
  
  METHODS
  We analyzed data collected by retrospective chart review for 208 patients presenting at seven French hospitals with an acute coronary syndrome (chest pain at rest within 24 h prior to presentation with positive cardiac markers and/or electrocardiographic changes) between January and March 2005.
  
  
  RESULTS
  Eighty-seven patients (42%) were first admitted to hospitals with cardiac catheterization facilities. One hundred ten patients (53%, 95% confidence interval [95% CI], 46-60) underwent early cardiac catheterization less than 48 h following presentation. In addition to presentation at hospitals with catheterization facilities, factors independently associated with early catheterization included positive cardiac markers in patients first admitted to hospitals without catheterization facilities (adjusted odds ratio [aOR] 34.5, 95% CI, 4.4-268.0) and diabetes mellitus (aOR, 0.4, 95%CI, 0.2-0.9). With the exception of positive cardiac markers, no risk factors comprising the TIMI risk score were associated with increased odds of early cardiac catheterization. During the index hospital stay, six patients (3%) died, seven patients (3%) had pulmonary edema, three patients (1%) had major or minor bleeding, and none had ST segment elevation myocardial infarction.
  
  
  CONCLUSIONS
  Despite the dissemination of international guidelines, the use of early cardiac catheterization remains related to initial presentation at hospitals with catheterization facilities rather than risk assessment in patients with a non ST-segment elevation acute coronary syndrome.
authors.affiliation: Réseau des urgences coronariennes (RESURCOR), réseau nord-alpin des urgences, centre hospitalier de la région d'Annecy, BP 2333, 74011 Annecy, France. lbelle@ch-annecy.fr
authors.forename: L
authors.initials: L
authors.lastname: Belle
authors.forename: J
authors.initials: J
authors.lastname: Labarere
authors.forename: O
authors.initials: O
authors.lastname: Meunier
authors.forename: V
authors.initials: V
authors.lastname: Amon
authors.forename: M
authors.initials: M
authors.lastname: Fourny
authors.forename: H
authors.initials: H
authors.lastname: Bouvaist
authors.forename: O
authors.initials: O
authors.lastname: Guenot
authors.forename: V
authors.initials: V
authors.lastname: Hugon
authors.forename: P
authors.initials: P
authors.lastname: Broin
authors.forename: P
authors.initials: P
authors.lastname: Fromage
authors.forename: C
authors.initials: C
authors.lastname: Haddad
authors.forename: P
authors.initials: P
authors.lastname: François
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D004562:Electrocardiography; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment