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Predictors of same-admission cardiac catheterization in patients with acute ischemic syndromes
S Kassam1, K Freskiw, K Sykora
1Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario.
Insights
Cardiac catheterization use increased in acute ischemic syndromes, but not solely due to patient factors. A potential shift towards more aggressive practice styles warrants further investigation in cardiology.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Practice Guidelines
Background:
- Cardiac catheterization is a key diagnostic and therapeutic tool for acute ischemic syndromes.
- Strategies for its use in unstable angina and non-Q wave myocardial infarction vary.
- An increase in cardiac catheterization volume was observed at the study institution.
Purpose of the Study:
- To determine if increased cardiac catheterization volume reflected a more invasive management approach for acute ischemic syndromes.
- To identify factors influencing the decision to perform cardiac catheterization during index admission.
Main Methods:
- Retrospective cohort study of coronary care unit admissions in 1990/91 and 1993/94.
- Random selection of 100 patients per study year with acute ischemic syndromes or undiagnosed chest pain.
- Documentation of cardiac catheterization use during the index hospital admission.
Main Results:
- A trend towards more frequent same-admission cardiac catheterization was observed in the later period (21% vs. 12%, P=0.09).
- After adjusting for baseline characteristics, admission year did not independently predict catheterization use (P=0.60).
- Recurrent chest pain and myocardial necrosis evidence were strongly associated with same-admission catheterization.
Conclusions:
- Clinical factors partially explain the increased use of cardiac catheterization over time.
- A potential shift towards a more aggressive practice style at the institution is suggested.
- Further research is necessary to confirm changes in practice style for acute ischemic syndromes.
Background:
Various strategies exist for the use of cardiac catheterization in unstable angina or non-Q wave myocardial infarction. At the authors' institution, the overall volume of cardiac catheterization has increased in recent years.
Objective:
To investigate whether this increased volume of cardiac catheterization was due to adoption of a more invasive approach to the management of patients with acute ischemic syndromes.
Design:
A retrospective cohort study was conducted using detailed chart review of coronary care unit admissions during 1990/91 and 1993/94.
Setting:
A university-affiliated tertiary care referral centre with facilities for cardiac catheterization.
Patients:
One hundred patients randomly selected from among those with unstable angina, non-Q wave myocardial infarction or chest pain not yet diagnosed in each of the study years. Detailed follow-up was complete for all patients.
Outcome Measure:
The use of cardiac catheterization during the index admission was documented.
Main Results:
There was a trend towards more frequent use of same admission cardiac catheterization in the later period (21% [CI 14% to 31%] versus 12% [CI 7% to 20%], P = 0.09). However, after controlling for baseline characteristics and in-hospital events, the year of admission did not independently predict the use of catheterization (P = 0.60). By multivariate logistic regression, recurrence of chest pain and evidence of myocardial necrosis were most closely associated with same-admission cardiac catheterization.
Conclusions:
Although clinical factors partially explain the increased use of catheterization over time, there may have also been shift towards a more aggressive practice style at the authors' institution. Further study is needed to address this possibility.