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CLINICAL STUDIES

Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources

Josep Lupón, MD^a, Vicente Valle, MD^a, Jaume Marrugat, MD^*, Roberto Elosua, MD^*, Lluis Serés, MD^a, Marco Pavesi, PhD^*, Román Freixa, MD^a, Ginés Sanz, MD, Rafel Masiá, MD, Lluis Molina, MD^¶, Joan Sala, MD, Jordi Serra, MD^a for the R.E.S.C.A.T.E. Investigators

^a Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
^* Department of Epidemiology and Public Health, Institut Municipal d’Investigació Mèdica, Barcelona, Spain
Institute of Cardiovascular Diseases, Hospital Clinic, Barcelona, Spain
Department of Cardiology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
^¶ Department of Cardiology, Hospital del Mar, Barcelona, Spain

Manuscript received December 3, 1998; revised manuscript received June 24, 1999, accepted August 27, 1999.

Reprint requests and correspondence: Dr. Jaume Marrugat, Departament d’Epidemiologia i Salut Pública, Institut Municipal d’Investigació Mèdica (IMIM), Carrer Doctor Aiguader 80, E-08003 Barcelona, Spain
JAUME{at}IMIM.ES

OBJECTIVES

The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes.

BACKGROUND

The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established.

METHODS

A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias.

RESULTS

Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67).

CONCLUSIONS

The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CI = confidence interval   CABG = coronary artery bypass grafting   ECG = electrocardiogram, electrocardiographic   PTCA = percutaneous transluminal coronary angioplasty   RESCATE = Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera   UA = unstable angina

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