Rory Miller, Garry Nixon, Robin M. Turner, Tim Stokes, Rawiri Keenan, Yannan Jiang, Corina Grey, and Andrew Kerr. “Outcomes and access to angiography following non-ST-segment elevation acute coronary syndromes in patients who present to rural or urban hospitals: ANZACS-QI 72.” The New Zealand Medical Journal 136, no. 1573 (2023): 27-54.

Take home messages for those of us working in rural hospitals: The NSTEACS patients we deal with have similar outcomes to those admitted to the bigger hospitals, which is something we can be really pleased about given international, and some of the old NZ, data comparing rural and urban outcomes. This is despite our patients having significantly lower rates of angiography.  It speaks to our acute management and ability to transfer the patients who will benefit from angiography. It looks like the survival curves do start to diverge after a year. This needs further exploration but raises questions about follow-up and secondary prevention for rural patients. Good job on this paper everyone in providing care for these patients.

Abstract

Aim

This study’s aim was to identify differences in invasive angiography performed and health outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) presenting to either i) a rural hospital, or an urban hospital ii) with or iii) without routine access to percutaneous intervention (PCI) in New Zealand.

Methods

Patients with NSTEACS between 1 January 2014 and 31 December 2017 were included. Logistic regression was used to model each of the outcome measures: angiography performed within 1 year; 30-day, 1-year and 2-year all-cause mortality; and readmission within 1 year of presentation with either heart failure, a major adverse cardiac event or major bleeding.

Results

There were 42,923 patients included. Compared to urban hospitals with access to PCI, the odds of a patient receiving an angiogram were reduced for rural and urban hospitals without routine access to PCI (odds ratio [OR] 0.82 and 0.75) respectively. There was a small increase in the odds of dying at 2 years (OR 1.16), but not 30 days or 1 year for patients presenting to a rural hospital.

Conclusion

Patients who present to hospitals without PCI are less likely to receive angiography. Reassuringly there is no difference in mortality, except at 2 years, for patients that present to rural hospitals.