Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes

Venu Menon, John S. Rumsfeld, Matthew T. Roe, Mauricio G. Cohen, Eric D. Peterson, Ralph G. Brindis, Anita Y. Chen, Charles V. Pollack, Sidney C. Smith, W. Brian Gibler, E. Magnus Ohman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed. Subjects and Methods: We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (<24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated. Results: Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case-fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast. Conclusions: Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case-fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalAmerican Journal of Medicine
Issue number7
StatePublished - Jul 2006
Externally publishedYes


  • Acute coronary syndromes
  • Non-ST elevation myocardial infarction
  • Outcomes
  • Regional variation

ASJC Scopus subject areas

  • Medicine(all)


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