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dc.contributor.authorVan de Werf, Frans
dc.contributor.authorGore, Joel M.
dc.contributor.authorAvezum, Alvaro
dc.contributor.authorGulba, Dietrich C.
dc.contributor.authorGoodman, Shaun G.
dc.contributor.authorBudaj, Andrzej
dc.contributor.authorBrieger, David
dc.contributor.authorWhite, Kami
dc.contributor.authorFox, Keith A. A.
dc.contributor.authorEagle, Kim A.
dc.contributor.authorKennelly, Brian M.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:09.000
dc.date.accessioned2022-08-23T15:44:10Z
dc.date.available2022-08-23T15:44:10Z
dc.date.issued2005-02-25
dc.date.submitted2011-09-23
dc.identifier.citationBMJ. 2005 Feb 26;330(7489):441. Epub 2005 Jan 21. <a href="http://dx.doi.org/10.1136/bmj.38335.390718.82">Link to article on publisher's site</a>
dc.identifier.issn0959-535X (Linking)
dc.identifier.doi10.1136/bmj.38335.390718.82
dc.identifier.pmid15665006
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27254
dc.description.abstractOBJECTIVE: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=15665006&dopt=Abstract">Link to Article in PubMed</a>
dc.subjectAged
dc.subjectFemale
dc.subjectHealth Services Accessibility
dc.subjectHeart Catheterization
dc.subjectHospitalization
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMyocardial Infarction
dc.subjectMyocardial Revascularization
dc.subjectOdds Ratio
dc.subjectPrognosis
dc.subjectProspective Studies
dc.subjectResidence Characteristics
dc.subjectRisk Factors
dc.subjectHealth Services Research
dc.titleAccess to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study
dc.typeArticle
dc.source.journaltitleBMJ (Clinical research ed.)
dc.source.volume330
dc.source.issue7489
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1071&amp;context=cor_grace&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/72
dc.identifier.contextkey2254993
refterms.dateFOA2022-08-23T15:44:10Z
html.description.abstract<p>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.</p> <p>DESIGN: Prospective, multinational, observational registry.</p> <p>SETTING: Patients enrolled in 106 hospitals in 14 countries between April 1999 and March 2003.</p> <p>PARTICIPANTS: 28,825 patients aged > or = 18 years.</p> <p>MAIN OUTCOME MEASURES: Use of percutaneous coronary intervention or coronary artery bypass graft surgery, death, infarction after discharge, stroke, or major bleeding.</p> <p>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).</p> <p>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.</p>
dc.identifier.submissionpathcor_grace/72
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages441


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