PMID- 24362735
OWN - NLM
STAT- MEDLINE
DCOM- 20140211
LR  - 20181202
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 126
IP  - 1387
DP  - 2013 Dec 13
TI  - Risk stratification and timing of coronary angiography in acute coronary 
      syndromes: are we targeting the right patients in a timely manner? (ANZACS-QI 1).
PG  - 69-80
AB  - AIMS: The New Zealand non-ST elevation acute coronary syndrome (NSTEACS) 
      guideline recommends that clinically appropriate patients with combined high risk 
      features (positive troponin and ischaemic ECG and a GRACE score >140) have 
      coronary angiography within the first hospital day. All other ACS patients 
      referred for angiography should be studied within 72 hours. We evaluated the 
      relationship between risk criteria, and both the incidence and timing of 
      angiography in our practice. METHODS: 2868 consecutive patients (2007 to 2010) 
      with NSTEACS admitted to Middlemore, Waikato and Taranaki Hospitals. Individual 
      patient demographic, risk factor, diagnostic, investigation and in-hospital 
      outcome data was collected prospectively using Acute PREDICT software. RESULTS: 
      391 (13.6%) patients met the combined high risk criteria. Compared with lower 
      risk patients they were older and more likely to have known cardiac disease, 
      diabetes, renal impairment, left ventricular failure, left ventricular systolic 
      dysfunction and more likely to die in hospital. Patients with combined high risk 
      were less likely than others to undergo coronary angiography (61.6% vs 75%, 
      p<0.0001). Only a fifth of combined high risk patients referred had coronary 
      angiography within 1 day. Only just over half of those referred for angiography 
      were studied within 3 days. CONCLUSIONS: The New Zealand guidelines high risk 
      criteria identify one in seven patients with NSTEACS as potentially appropriate 
      for angiography within the first day. For those referred this was infrequently 
      achieved, and only half of all NSTEACS patients referred met the 3-day target. 
      Implementation of a national ACS registry to support more appropriate and timely 
      management is appropriate.
FAU - Kerr, Andrew J
AU  - Kerr AJ
AD  - Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland 93311, New 
      Zealand. Andrew.Kerr@middlemore.co.nz.
FAU - Lin, Aaron
AU  - Lin A
FAU - Lee, Mildred
AU  - Lee M
FAU - Ternouth, Ian
AU  - Ternouth I
FAU - Killion, Bridget
AU  - Killion B
FAU - Devlin, Gerry
AU  - Devlin G
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131213
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
SB  - IM
CIN - N Z Med J. 2013;126(1387):10-4. PMID: 24362731
MH  - Acute Coronary Syndrome/diagnosis/*diagnostic imaging
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - *Coronary Angiography/statistics & numerical data
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Selection
MH  - *Risk Assessment
MH  - Risk Factors
MH  - Time Factors
EDAT- 2013/12/24 06:00
MHDA- 2014/02/12 06:00
CRDT- 2013/12/24 06:00
PHST- 2013/12/24 06:00 [entrez]
PHST- 2013/12/24 06:00 [pubmed]
PHST- 2014/02/12 06:00 [medline]
PST - epublish
SO  - N Z Med J. 2013 Dec 13;126(1387):69-80.