title: Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes.
abstract: BACKGROUND
  There has been a paradigm shift in the definition of timing of early invasive strategy (EIS) for patients admitted with non-ST-elevation myocardial infarction (NSTEMI) in the last decade. Data on trends of EIS for NSTEMI and associated in-hospital outcomes are limited. Our aim is to analyze temporal trends in the incidence, utilization of early invasive strategy, and in-hospital outcomes of NSTEMI in the United States.
  
  
  RESULTS
  We analyzed the 2002-2011 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with the principal diagnosis of acute myocardial infarction (AMI) and NSTEMI. Logistic regression was used for overall, age-, sex-, and race/ethnicity-stratified trend analysis. From 2002 to 2011, we identified 6 512 372 patients with AMI. Of these, 3 981 119 (61.1%) had NSTEMI. The proportion of patients with NSTEMI increased from 52.8% in 2002 to 68.6% in 2011 (adjusted odds ratio [OR; per year], 1.055; 95% confidence interval [CI], 1.054 to 1.056) in the overall cohort. Similar trends were observed in age-, sex-, and race/ethnicity-stratified groups. From 2002 to 2011, utilization of EIS at day 0 increased from 14.9% to 21.8% (Ptrend<0.001) and utilization of EIS at day 0 or 1 increased from 27.8% to 41.4% (Ptrend<0.001). Risk-adjusted in-hospital mortality in the overall cohort decreased during the study period (adjusted OR [per year], 0.976; 95% CI, 0.974 to 0.978).
  
  
  CONCLUSIONS
  There have been temporal increases in the proportion of NSTEMI and, consistent with guidelines, greater utilization of EIS. This has been accompanied by temporal decreases in in-hospital mortality and length of stay.
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Sahil
authors: S
authors: Khera
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Dhaval
authors: D
authors: Kolte
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Wilbert S
authors: WS
authors: Aronow
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Chandrasekar
authors: C
authors: Palaniswamy
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Kathir Selvan
authors: KS
authors: Subramanian
authors: University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.).
authors: Taimoor
authors: T
authors: Hashim
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Marjan
authors: M
authors: Mujib
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Diwakar
authors: D
authors: Jain
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Rajiv
authors: R
authors: Paudel
authors: University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.).
authors: Ali
authors: A
authors: Ahmed
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: William H
authors: WH
authors: Frishman
authors: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.).
authors: Julio A
authors: JA
authors: Panza
authors: David-Geffen School of Medicine University of California at Los Angeles (UCLA), Los Angeles, CA (G.C.F.).
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000706:statistics & numerical data* / Q000639:trends; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data* / Q000639:trends; D061345:Early Medical Intervention; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: early invasive strategy; in‐hospital mortality; non‐ST‐elevation myocardial infarction; temporal trends