Abstract 354: Non-ST-Elevation Myocardial Infarction: Admissions, Rate, and Timing of Revascularization in The United States

Objectives: This study aimed to evaluate non-ST-elevation myocardial infarction (NSTEMI) rates, revascularization timing, and mortality rates using the Nationwide Readmissions Database (NRD). Background: Clinical trials have shown improved outcomes with reduced mortality with an early invasive approach for NSTEMI. However, real-world data are lacking. Methods: The study cohort was obtained from the 2016 NRD dataset. We used the International Classification of Diseases, Tenth Revision, to identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Results: Our analysis included 748,463 NSTEMI admissions in 2016. Of these admissions, 50.1% (374,988) underwent diagnostic angiography with 38.9% (253,492) revascularized: 77.6% (197,945) PCI and 22.4% (57,254) CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission, 32.9% (65,155). This differs from CABG, which was most commonly performed on Day 3 after admission, 13.7% (7,823). The in-hospital mortality rate increased after Day 1 for PCI patients and after Day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed (Figure 1). Conclusions: Our study shows that mortality generally increased as revascularization was delayed, while sicker patients tended to have longer delays until revascularization. However, confounding variables prevent definite causal attribution. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients.