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Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units

Urban university maximum care vs. rural regional primary care

Leitlinienadhärentes Timing der invasiven Diagnostik bei NSTEMI und Hochrisiko-NSTE-ACS in deutschen Chest Pain Units

Universitäre Versorgung im städtischen Bereich vs. Regel- und Schwerpunktversorgung im ländlichen Bereich

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Abstract

Aim

This study aimed to analyze guideline adherence in the timing of invasive management for myocardial infarction without persistent ST-segment elevation (NSTEMI) in two exemplary German centers, comparing an urban university maximum care facility and a rural regional primary care facility.

Methods

All patients diagnosed as having NSTEMI during 2013 were retrospectively enrolled in two centers: (1) site I, a maximum care center in an urban university setting, and (b) site II, a primary care center in a rural regional care setting. Data acquisition included time intervals from admission to invasive management, risk criteria, rate of intervention, and medical therapy.

Results

The median time from admission to coronary angiography was 12.0 h (site I) or 17.5 h (site II; p = 0.17). Guideline-adherent timing was achieved in 88.1 % (site I) or 82.9 % (site II; p = 0.18) of cases. Intervention rates were high in both sites (site I—75.5 % vs. site II—75.3 %; p = 0.85). Adherence to recommendations of medical therapy was high and comparable between the two sites.

Conclusion

In NSTEMI or high-risk acute coronary syndromes without persistent ST-segment elevation, guideline-adherent timing of invasive management was achieved in about 85 % of cases, and was comparable between urban maximum and rural primary care settings. Validation by the German Chest Pain Unit Registry including outcome analysis is required.

Zusammenfassung

Zielsetzung

In der vorliegenden Studie wird das leitlinienadhärente Vorgehen in Bezug auf das Timing der invasiven Diagnostik beim Nicht-ST-Strecken-Hebungsinfarkt (NSTEMI) in 2 unterschiedlichen deutschen Chest Pain Units (CPU) analysiert und verglichen – unter Gegenüberstellung eines universitären Maximalversorgers im städtischen Bereich (Zentrum I) und einer Klinik der Regel- und Schwerpunktversorgung in ländlicher Region (Zentrum II).

Methoden

Alle Patienten, die mit der Diagnose eines NSTEMI während des Jahres 2013 aus den beiden Zentren entlassen wurden, wurden retrospektiv in die Studie eingeschlossen. Die Datenanalyse umfasste die Zeitintervalle von der Aufnahme bis zur Koronarangiographie, Risikomerkmale, Interventionsraten und die medikamentöse Therapie.

Ergebnisse

Die Zeit von der stationären Aufnahme bis zur Koronarangiographie betrug im Median 12 (Zentrum I) bzw. 17,5 h (Zentrum II; p = 0,17). Ein leitlinienkonformes Timing wurde bei 88,1 % (Zentrum I) bzw. 82,9 % der Patienten (Zentrum II; p = 0,18) erzielt. Die Interventionsraten (Zentrum I – 75,5 % vs. Zentrum II – 75,3 %; p = 0,85) sowie die Leitlinienadhärenz in Bezug auf die medikamentöse Therapie waren in beiden Zentren vergleichbar hoch.

Schlussfolgerung

Die vorliegende Analyse zeigt mit etwa 85 % eine hohe Leitlinienadhärenz bezüglich des Timings der invasiven Abklärung beim NSTEMI oder beim akuten Hochrisiko-Koronarsyndrom ohne persistierende ST-Strecken-Hebung (NSTE-ACS). Sowohl universitärer Maximalversorger als auch regionaler Regel- und Schwerpunktversorger weisen ähnliche Ergebnisse auf. Eine breite Validierung, z. B. durch das deutsche CPU-Register, steht noch aus.

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Acknowledgments

This work is part of the doctoral thesis of F. Remberg.

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Authors and Affiliations

  1. Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany

    F. Breuckmann, F. Remberg & D. Böse

  2. Department of Angiology, Arnsberg Medical Center, Arnsberg, Germany

    M. Lichtenberg

  3. Department of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany

    P. Kümpers & H. Pavenstädt

  4. Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany

    J. Waltenberger & D. Fischer

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  1. F. Breuckmann
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Correspondence to F. Breuckmann.

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Conflict of interest

F. Breuckmann, F. Remberg, D. Böse, M. Lichtenberg, P. Kümpers, H. Pavenstädt, J. Waltenberger, and D. Fischer state that there are no conflicts of interest.

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Breuckmann, F., Remberg, F., Böse, D. et al. Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units. Herz 41, 151–158 (2016). https://doi.org/10.1007/s00059-015-4354-8

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  • DOI: https://doi.org/10.1007/s00059-015-4354-8

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