Limitations of using cardiac catheterization rates to assess the quality of care for patients with non-ST-segment elevation myocardial infarction.
BACKGROUND
An early invasive management strategy is recommended for patients with non-ST-segment elevation myocardial infarction (NSTEMI) who do not have a contraindication to cardiac catheterization (CCC). However, the frequency of CCC reporting has not been delineated, and the relationship of CCC reporting to hospital-level guidelines adherence for NSTEMI has not been investigated.


METHODS
We used the American College of Cardiology National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines database to evaluate variations in hospital-level reporting of CCC for 111,320 patients with NSTEMI admitted to 370 hospitals with revascularization capabilities in the United States from 2007 to 2010 and how these variations were associated with guideline adherence and in-hospital mortality. Hospitals were grouped into tertiles based on rates of reported CCCs. Treatment patterns and in-hospital mortality rates were evaluated across hospital tertiles separately for patients with and without a reported CCC.


RESULTS
A total of 18,290 (16.4%) of 111,320 patients with NSTEMI had a reported CCC, but hospital-level CCC reporting varied considerably (low tertile 0%-8.2%, intermediate tertile >8.2%-18.8%, and high tertile >18.8%-75.6%). Patients with a reported CCC had more comorbidities and high-risk features compared with patients without a CCC. The use of most guideline-recommended medications and in-hospital mortality rates were similar across hospital tertiles-both for patients with and without a reported CCC.


CONCLUSIONS
The reporting of CCC among patients with NSTEMI varies widely across US hospitals and does not appear to be related to guidelines adherence or in-hospital mortality rates. These findings suggest that it will be a challenge to standardize the reporting of CCC and thus use invasive management to assess the quality of NSTEMI care.
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Sergio
S
Leonardi
Anita Y
AY
Chen
S Michael
SM
Gharacholou
Tracy Y
TY
Wang
James A
JA
de Lemos
Jorge F
JF
Saucedo
Eric D
ED
Peterson
Matthew T
MT
Roe
D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000401:mortality / Q000706:statistics & numerical data; D000077144:Clopidogrel; D015897:Comorbidity; D000075202:Contraindications; D019091:Critical Pathways; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012042:Registries; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States
D058671:Adrenergic beta-1 Receptor Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin