Access to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study
Authors
Van de Werf, FransGore, Joel M.
Avezum, Alvaro
Gulba, Dietrich C.
Goodman, Shaun G.
Budaj, Andrzej
Brieger, David
White, Kami
Fox, Keith A. A.
Eagle, Kim A.
Kennelly, Brian M.
GRACE Investigators
UMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2005-02-25Keywords
AgedFemale
Health Services Accessibility
Heart Catheterization
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction
Myocardial Revascularization
Odds Ratio
Prognosis
Prospective Studies
Residence Characteristics
Risk Factors
Health Services Research
Metadata
Show full item recordAbstract
OBJECTIVE: To investigate the relation between access to a cardiac catheterisation laboratory and clinical outcomes in patients admitted to hospital with suspected acute coronary syndrome. DESIGN: Prospective, multinational, observational registry. SETTING: Patients enrolled in 106 hospitals in 14 countries between April 1999 and March 2003. PARTICIPANTS: 28,825 patients aged > or = 18 years. MAIN OUTCOME MEASURES: Use of percutaneous coronary intervention or coronary artery bypass graft surgery, death, infarction after discharge, stroke, or major bleeding. RESULTS: Most patients (77%) across all regions (United States, Europe, Argentina and Brazil, Australia, New Zealand, and Canada) were admitted to hospitals with catheterisation facilities. As expected, the availability of a catheterisation laboratory was associated with more frequent use of percutaneous coronary intervention (41% v 3.9%, P < 0.001) and coronary artery bypass graft (7.1% v 0.7%, P < 0.001). After adjustment for baseline characteristics, medical history, and geographical region there were no significant differences in the risk of early death between patients in hospitals with or without catheterisation facilities (odds ratio 1.13, 95% confidence interval 0.98 to 1.30, for death in hospital; hazard ratio 1.05, 0.93 to 1.18, for death at 30 days). The risk of death at six months was significantly higher in patients first admitted to hospitals with catheterisation facilities (hazard ratio 1.14, 1.03 to 1.26), as was the risk of bleeding complications in hospital (odds ratio 1.94, 1.57 to 2.39) and stroke (odds ratio 1.53, 1.10 to 2.14). CONCLUSIONS: These findings support the current strategy of directing patients with suspected acute coronary syndrome to the nearest hospital with acute care facilities, irrespective of the availability of a catheterisation laboratory, and argue against early routine transfer of these patients to tertiary care hospitals with interventional facilities.Source
BMJ. 2005 Feb 26;330(7489):441. Epub 2005 Jan 21. Link to article on publisher's siteDOI
10.1136/bmj.38335.390718.82Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27254PubMed ID
15665006Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1136/bmj.38335.390718.82