Temporal trends in the use of early cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes (results from CRUSADE).
We evaluated temporal trends in the use of early (<48 hours) catheterization in patients with non-ST-segment elevation acute coronary syndromes with respect to baseline risk features since publication of the American College of Cardiology/American Heart Association guidelines, which include a class IA recommendation for an early invasive strategy for high-risk patients with non-ST-segment elevation acute coronary syndromes. Overall, we found that early catheterization use increased from 53% to 61% during the 3 years after the guidelines were released, but the increased use of early catheterization was highest (11%) in the group that was at lowest risk of predicted mortality, and it was lowest (6%) in the group at highest risk of predicted mortality who would potentially receive the most benefit from an aggressive treatment approach. In conclusion, despite the overall increase in the use of early catheterization, the gap between the use of an early invasive strategy in the highest and lowest risk patients remains large and tends to increase over time.
Tricoci
Pierluigi
P
Division of Cardiology and the Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina USA. trico001@dcri.duke.edu
Peterson
Eric D
ED
Mulgund
Jyotsna
J
Newby
L Kristin
LK
Saucedo
Jorge F
JF
Kleiman
Neil S
NS
Bhatt
Deepak L
DL
Berger
Peter B
PB
Cannon
Christopher P
CP
Cohen
David J
DJ
Hochman
Judith S
JS
Ohman
E Magnus
EM
Gibler
W Brian
WB
Harrington
Robert A
RA
Smith
Sidney C
SC
Roe
Matthew T
MT
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000706:statistics & numerical data* / Q000639:trends*; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D015996:Survival Rate; D013577:Syndrome; D013997:Time Factors; D014481:United States / Q000453:epidemiology