{
  "abstract": "Background Routine invasive management by coronary angiography and revascularisation as appropriate reduces recurrent ischaemic events in non-ST-segment myocardial infarction (NSTEMI), but its mortality benefit is uncertain.Methods Within this state-wide retrospective cohort study, patients with a primary diagnosis of NSTEMI were identified from the New South Wales (NSW) Admitted Patient Data Collection database between 2003 and 2020 and linked to the NSW death registry. Primary outcomes were cardiovascular (CV) and all-cause mortality among NSTEMI patients stratified by in-hospital invasive management.Results Among 121 089 patients with NSTEMI (median age 71.4 years; 62.7% men), invasive management increased from 48.8% to 66.8% while all-cause in-hospital mortality decreased from 4.8% to 2.9% between triennial periods of 2003–2005 and 2018–2020, respectively. During the follow-up period (median 8.47 years), 47 304 (39.1%) patients died. CV mortality fell between 2003 and 2020 for those who were and were not invasively managed with greater magnitude in the former (subdistribution HR (sHR)=0.32, 95% CI 0.29 to 0.36; sHR=0.58, 95% CI 0.54 to 0.63, respectively, p interaction<0.001). For all-cause mortality, the fall was significant for the invasively managed patients, with no plateau evident, but not in patients managed conservatively (adjusted HR (aHR)=0.56, 95% CI 0.52 to 0.61; aHR=1.00, 95% CI 0.95 to 1.06, respectively, pinteraction<0.001).Conclusions In patients presenting to NSW hospitals with NSTEMI between 2003 and 2020, we observed improvements in CV mortality in both invasively and conservatively managed patients while all-cause mortality improved in invasively but not conservatively managed patients. Wider implementation of routine invasive management may further improve long-term mortality among NSTEMI patients in NSW.",
  "authors": [
    {
      "affiliations": [
        "The University of Notre Dame Australia School of Medicine Sydney Campus, Darlinghurst, New South Wales, Australia"
      ],
      "name": "Benjamin Juergens"
    },
    {
      "affiliations": [
        "ANZAC Research Institute, Concord, New South Wales, Australia",
        "The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Karice Hyun"
    },
    {
      "affiliations": [
        "ANZAC Research Institute, Concord, New South Wales, Australia",
        "The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Teber Erdahl"
    },
    {
      "affiliations": [
        "ANZAC Research Institute, Concord, New South Wales, Australia",
        "The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Boroumand Farzaneh"
    },
    {
      "affiliations": [
        "Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"
      ],
      "name": "Austin CC Ng"
    },
    {
      "affiliations": [
        "ANZAC Research Institute, Concord, New South Wales, Australia",
        "Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"
      ],
      "name": "David B Brieger"
    }
  ],
  "title": "Observational analysis of non-ST-segment elevation myocardial infarction invasive management and mortality over the decades",
  "uid": "0e9ab336-073f-5f7a-9d95-80d3d6fd8ec2"
}