Landewe, M.J. (2024) Time Matters: The implementation of an early invasive strategy reduces time intervals in ‘high-risk’ NSTE-ACS patients at Deventer Hospital. thesis, Medicine.
Full text available on request.Abstract
Introduction: Since the recommendation for an early invasive strategy in 'high-risk' Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients was included in the 2015 European Society of Cardiology guideline, it has been a topic of debate in the Netherlands. Although the existing literature does not fully consider the perspective of Dutch non-PCI centres, the Deventer Hospital has nevertheless implemented this recommendation. The aim of this study is to examine the impact of an early invasive strategy on relevant time intervals in the care process of NSTE-ACS patients. Methods: This retrospective observational single-centre study examined the impact of implementing an 'early invasive strategy’ for high-risk NSTE-ACS patients admitted between March 31, 2015, and April 1, 2019. Patients were divided into two groups: period A (pre-implementation) and period B (post-implementation). Primary endpoints included time intervals from admission to coronary angiography (CAG), CAG to Heart Team consultation, Heart Team to revascularization, and total length of hospital stay. Results: In total, 420 high-risk NSTE-ACS patients were included, with 220 in Period A and 200 in Period B. The median time from hospital admission to CAG decreased significantly from 34.5 hours (IQR: 23.0 - 61.5) in Period A to 20 hours (IQR: 10.0 - 25.0) in Period B (p < 0.001). This resulted in shorter hospital stays for patients undergoing PCI (Period A 190.5h; IQR: 156.5 - 234.0 vs Period B 150h; IQR: 111.5-188.5) (p<0.001). Furthermore, there was a significant reduction in the interval between admission and PCI from 156.5 hours (IQR: 130.8 - 193.3) in Period A to 124 hours (IQR: 91.3 - 162.0) in Period B (p < 0.001). Conclusions: The early invasive strategy in high-risk NSTE-ACS patients of Deventer Hospital is effective in reducing the time from admission to CAG, admission to PCI and total length of hospital stay for patients undergoing PCI.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | dr. van der Sluis, A. and dr.Badings, E.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 21 Oct 2024 11:54 |
| Last Modified: | 21 Oct 2024 11:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3771 |
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