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On-site catheterization laboratory and prognosis after acute myocardial infarction. Israeli Thrombolytic Survey Group
1Israeli Thrombolytic Survey Group, Neufeld Cardiac Research Institute Sheba Medical Center, Tel Hashomer, Israel.
Insights
The availability of on-site coronary angiography facilities significantly increased the use of diagnostic and therapeutic procedures for acute myocardial infarction patients. However, this did not impact in-hospital or one-year mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Thrombolytic therapy has increased the use of coronary angiography.
- The study investigated the impact of on-site catheterization facilities on procedure utilization in acute myocardial infarction (AMI) patients.
Purpose of the Study:
- To determine if on-site coronary angiographic facilities influence the utilization of coronary procedures in AMI patients.
- To assess the impact of facility availability on patient outcomes.
Main Methods:
- A prospective survey of 25 coronary care units in Israel was conducted.
- Data collected included demographics, clinical features, thrombolytic therapy, and coronary procedures.
- In-hospital and 1-year mortality were assessed for all patients.
Main Results:
- Hospitals with on-site angiography performed more coronary angiography (26% vs. 10%) and revascularization procedures (12% vs. 5%).
- Thrombolytic therapy use was similar (46%) regardless of facility availability.
- In-hospital (11% vs. 10%) and 1-year mortality (18% vs. 17%) showed no significant difference between groups.
Conclusions:
- On-site invasive coronary facilities increase the use of diagnostic and therapeutic procedures for AMI.
- The availability of these facilities does not affect hospital or 1-year mortality rates.
- This suggests improved access to interventions without compromising patient survival.
Background:
Since the introduction of thrombolytic therapy for patients with acute myocardial infarction, the use of coronary angiography has substantially increased. We sought to determine whether the presence of on-site coronary angiographic facilities influenced the utilization of coronary procedures in patients with acute myocardial infarction hospitalized in Israel's coronary care units.
Methods:
A prospective survey was conducted in January and February 1992 in the 25 coronary care units operating in Israel, 15 of which had on-site catheterization facilities. Data on demographics, clinical features, thrombolytic therapy, and the type of coronary diagnostic or therapeutic procedures performed during the current in-hospital stay were recorded. Mortality, both in-hospital and 1 year after discharge, was assessed for all patients in the survey.
Results:
One thousand fourteen consecutive patients with acute myocardial infarction were hospitalized during the survey, 307 (30%) of whom were admitted to 10 coronary care units without and 707 of whom were treated in hospitals with on-site coronary angiography facilities. Demographic and baseline characteristics were similar in both groups. Thrombolytic therapy was provided equally (46%) to patients admitted to hospital with and without catheterization laboratories. Patients admitted to hospitals with these laboratories underwent coronary angiography (26%) and percutaneous transluminal angioplasty and/or coronary artery bypass grafting (12%) in greater numbers than counterparts admitted to hospitals without such laboratories (10% and 5%, respectively). Hospital and cumulative 1-year mortality rates were 11% and 18%, respectively, in patients admitted to hospitals with on-site catheterization facilities vs 10% and 17%, respectively, in the patient group admitted to the other hospitals. Patients receiving thrombolytic therapy had similar hospital mortality rates unrelated to the availability of coronary catheterization laboratories.
Conclusion:
This national survey showed that the availability of invasive coronary facilities led to increased use of diagnostic and therapeutic coronary procedures among patients with acute myocardial infarction. There was no difference in hospital or 1-year mortality rates in patients admitted to hospitals with or without on-site coronary angiographic facilities.