Associazione Nazionale Medici Cardiologi Ospedalieri

CONGRESS ABSTRACT

CONGRESS ABSTRACT

IMPACT OF DISCHARGE FROM A CARDIOLOGY UNIT ON OUTCOMES IN NON-ST ELEVATION MYOCARDIAL INFARCTION: AN ANALYSIS OF A NATIONWIDE ADMINISTRATIVE DATABASE

D’Errigo Paola Roma(Roma) – Istituto Superiore di Sanità | De Luca Leonardo Roma(Roma) – Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini | Rosato Stefano Roma(Roma) – Istituto Superiore di Sanità

Background: Current data on the prognostic impact of a specialist management of patients with acute coronary syndromes are scarce.

Aim: To evaluate the impact of the discharge of revascularized patients with Non-ST elevation myocardial infarction (NSTEMI) from a cardiology unit on their 1-year prognosis and to evaluate the differences in terms of effectiveness between discharge from a cardiology and non-cardiology unit and the whole management of the index hospitalization in a cardiology unit.

Methods: Retrospective nationwide cohort study enrolling consecutive patients older than 18 years admitted in 2019-2020 in Italy for a NSTEMI and undergoing percutaneous coronary intervention (PCI) within 48 hours from the index admission. Patients died within 30 days from the index admission were excluded from the analysis. Enrolled patients were classified based on the management department into: patients not discharged from a cardiology unit (group 1); patients not admitted but discharged from a cardiology unit (group 2); patients completely managed (admitted and discharged) in a cardiology unit (group 3). The outcome of interest was 1-year all-cause mortality. A Cox multivariate regression model was used to evaluate the impact of the management department on 1-year mortality.

Results: The study cohort consisted of 31950 NSTEMI events. Among them, 534 (1.6%) were allocated in group 1, 1160 (3.6%) in group 2 and 30256 (94.7%) in group 3. Patients completely managed by a cardiology unit were younger and less likely to be female than patients in other groups. The 1-year mortality was 14.4%, 8.4% and 3.8% (0.001) for group 1, group 2 and group 3, respectively (Figure). After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 1-year mortality was 2.4 (0.0001) and 1.7 (0.0001), in patients in group 1 and group 2, respectively, as compared with patients completely managed in a cardiology unit (group 3).

Conclusion: Complete management of index hospitalization or hospital discharge from a specialist unit alone improves the one-year prognosis of patients hospitalized with a diagnosis of NSTEMI in Italy.