Direct Admission Versus Interhospital Transfer for revascularisation in non-ST-Segment Elevation Myocardial Infarction

Abstract

Abstract Objective We aim to compare quality parameters, costs and clinical outcomes of NSTEMI patients stratified by centre of first presentation and revascularisation strategy. Methods Hospital claim data on patients admitted with a NSTEMI between 2017 and 2019 from one of the largest health insurers in the Netherlands were used for this study. Included patients were stratified by revascularisation strategy (PCI, CABG or no revascularisation [noRevasc]) and subdivided by centre of presentation per treatment. The primary outcomes were the following quality measures: duration between admission and revascularisation, length of hospital stay and number of intracoronary procedures. Total costs (accumulation of costs for hospital claims and inter-hospital ambulance rides) and clinical outcomes at 30 days (MACE: all-cause mortality, recurrent myocardial infarction and cardiac readmission) were used as secondary outcomes. Results A total of 9641 NSTEMI events (9167 unique patients) were analysed for which PCI was performed during admission in 4448 cases, CABG in 816 cases and no revascularisation was performed in 4377 cases. Direct presentation at an intervention centre occurred in 59%, 55% and 60% of cases, respectively. For PCI, direct presentation at an intervention centre yielded shorter time to revascularisation, shorter hospitalisation and less intracoronary procedures per patient. For CABG, time to revascularisation and hospitalisation were shorter. Total costs were significantly lower in case of direct presentation in an intervention centre for all treatment groups while MACE was similar. Conclusion Direct admission of NSTEMI patients to an intervention centre might yield improvement potential for current NSTEMI care.