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(Circulation. 1997;96:1770-1775.)
© 1997 American Heart Association, Inc.
Articles |
Long-term Outcome in Acute Myocardial Infarction Patients Admitted to Hospitals With and Without On-site Cardiac Catheterization Facilities
From the Northwest Health Services Research and Development Field Program, Seattle Veterans Affairs Medical Center (N.R.E., S.D.F.); the Department of Medicine, University of Washington (E.B.L.); and the MITI Coordinating Center, Division of Cardiology, Department of Medicine, University of Washington (L.S.P., C.M., A.P.H., J.S.M.), Seattle, Wash; and the Division of Cardiology, Henry Ford Health Care System, Detroit, Mich (W.D.W.).
Correspondence to Nathan Every, MD, MPH, MITI Coordinating Center, 1910 Fairview Ave E, #205, Seattle WA 98102. E-mail nevery{at}u.washington.edu
Background Previous studies have documented the strong association between availability of on-site cardiac catheterization facilities and increased use of coronary angiography in patients with acute myocardial infarction (AMI). Although these studies have shown little influence of the availability of catheterization labs on hospital mortality, no long-term follow-up has been reported.
Methods and Results From a cohort of 12 331 AMI patients admitted to 19 Seattle area hospitals, we compared long-term outcome in 7985 patients admitted to hospitals with and 4346 patients admitted to hospitals without on-site catheterization labs. During the index hospitalization, patients admitted to hospitals with on-site catheterization were more likely to undergo coronary angiography (67.1% versus 39.3%, P<.0001), coronary angioplasty (32.5% versus 13.2%, P<.0001), or coronary bypass surgery (12.5% versus 9.5%, P<.0001). At 3-year follow-up, patients admitted to hospitals with on-site catheterization labs were more likely to undergo postdischarge angiography (19.2% versus 15.2%, P=.0001) and coronary angioplasty (11.6% versus 8.2%, P<.0001). This was associated with approximately $2500.00 per patient in higher cumulative costs. Despite this higher rate of procedure use, there was no association between admission to a hospital with on-site catheterization facilities and lower long-term mortality (multivariate hazard ratio, 1.0; 95% CI, 0.93 to 1.1., the hazard being associated with admission to hospitals with on-site catheterization facilities).
Conclusions In an urban area with unconstrained patient transfer mechanisms and high overall cardiac procedure use rates, AMI patients admitted to hospitals without on-site catheterization facilities were managed with fewer procedures during hospitalization and follow-up. This more conservative treatment approach was not associated with any observed increase in long-term mortality.
Key Words: catheterization • myocardial infarction • cost-benefit analysis • mortality
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