Copyright © 1998 by the European Society of Cardiology.
Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective
a Division of Clinical Pharmacology, Leicester Royal Infirmary, Leicester, U.K.
b Department of Clinical Pharmacology, CSU Vall Hebron, Barcelona, Spain
c Clinic for Internal Medicine, University of Innsbruck, Innsbruck, Austria
d Maria Hospital, Helsinki, Finland
e Hygeia Hospital, Athens, Greece
f Unite de Pharmacologie Clinique, Lyon, France
g Research Forum, Ulleval University Hospital, Oslo, Norway
h Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
i Intituto do Coração, Linda-A-Velha, Portugal
j Laboratory for Cardiovascular Rehabilitation, Kaunas, Lithuania
k Department of Medicine, Östra Hospital, Göteborg, Sweden
accepted February 25, 1998
Aims
There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions concerning the impact of the high rate of these cardiac procedures.
Methods and Results
A population-based patient sampling approach was utilized to identify routine practice in representative samples from 11 European countries. Data were collected retrospectively on treatment in the 6 months following acute myocardial infarction (n=2807). There was wide variation in utilization of coronary angi-ography and revascularization procedures. Even after restricting the analysis to patients <65 years (n=1262), there remained a 6–13 fold variation in the use of these procedures. A decreased likelihood of undergoing these procedures was associated with older age. In addition, there was an independent and negative association between female sex and utilization of coronary angiography and coronary artery bypass grafting (CABG).
Conclusion
The effect on patient outcome of the observed variation in use of these procedures is not known but has important cost and resource implications for the health services. Outcome research is needed to define patient selection criteria and to measure the cost-utility of different angiography and revascularization rates.
f1 Correspondence: Professor K. L. Woods, Department of Medicine and Therapeutics, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, U.K.
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