This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alter, D. A. Articles by Naylor, C. D. Search for Related Content PubMed PubMed Citation Articles by Alter, D. A. Articles by Naylor, C. D.

CLINICAL STUDY

Waiting times, revascularization modality, and outcomes after acute myocardial infarction at hospitals with and without on-site revascularization facilities in Canada

David A. Alter, MD, PhD^*,*, Jack V. Tu, MD, PhD^*||¶#, Peter C. Austin, PhD^*¶ and C. David Naylor, MD, DPhil^*||¶#

^* Institute for Clinical Evaluative Sciences, Toronto, Canada
Division of Cardiology, Schulich Heart Centre, Sunnybrook and Women’s College Health Sciences Centre and the University of Toronto, Toronto, Canada
Faculty of Medicine, University of Toronto, Toronto, Canada
University of Toronto Clinical Epidemiology and Health Care Research Program (Sunnybrook and Women’s College Site), Toronto, Canada
^|| Division of General Internal Medicine, Sunnybrook and Women’s College Health Sciences Centre and the University of Toronto, Toronto, Canada
^¶ Department of Public Health Sciences, University of Toronto, Toronto, Canada
^# Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

Manuscript received November 4, 2002; revised manuscript received December 20, 2002, accepted February 6, 2003.

^* Reprint requests and correspondence: Dr. David A. Alter, Institute for Clinical Evaluative Sciences, G106-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
david.alter{at}ices.on.ca

OBJECTIVES: This study was designed to determine whether admission to a Canadian hospital with on-site revascularization (invasive hospital) affected revascularization choice, timing, and outcome compared with community (non-invasive) hospitals.

BACKGROUND: Health care systems in Canada are characterized by relative restraint in diffusion of tertiary cardiovascular services, with capacity for revascularization procedures concentrated in large regional referral centers.

METHODS: We used linked administrative data and a clinical registry to follow-up 15,166 Ontario patients who underwent revascularization within the year after their index acute myocardial infarction (MI). Outcomes included recurrent urgent cardiac hospitalization, hospital bed-days, and death within the same year after the index admission. We adjusted for age, gender, socioeconomic status, illness severity, attending physician specialty, and academic hospital affiliation.

RESULTS: After adjusting for baseline factors, patients admitted to invasive hospitals were more likely to receive angioplasty than bypass surgery (adjusted odds ratio: 1.85; 95% confidence interval: 1.68 to 2.04, p < 0.001). The converse pattern was seen for patients admitted to community hospitals. Median revascularization waiting times were significantly shorter at invasive hospitals (12 vs. 48 days, p < 0.001). Patients admitted to invasive hospitals had fewer cardiac re-admissions (41.5 vs. 68.9 events per 100 patients, p < 0.001) before their first revascularization and consumed fewer hospital bed-days (379 vs. 517 per 100 patients, p < 0.001). There were no differences in outcomes beyond revascularization.

CONCLUSIONS: Outcome advantages associated with timely post-MI revascularization highlight the importance of organizing revascularization referral networks and facilitating access to revascularization for patients with acute coronary syndromes admitted to community hospitals in Canada.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   AMI   acute myocardial infarction   CI   confidence interval   ICD-9   International Classification of Diseases-9th Revision   MI   myocardial infarction   OMID   Ontario Myocardial Infarction Database   OR   odds ratio   RR   relative risk

This article has been cited by other articles:

				D. T. Ko, Y. Wang, D. A. Alter, J. P. Curtis, S. S. Rathore, T. A. Stukel, F. A. Masoudi, J. S. Ross, J. M. Foody, and H. M. Krumholz Regional Variation in Cardiac Catheterization Appropriateness and Baseline Risk After Acute Myocardial Infarction. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 716 - 723. [Abstract] [Full Text] [PDF]

				D. T. Ko, H. M. Krumholz, Y. Wang, J. M. Foody, F. A. Masoudi, E. P. Havranek, J. J. You, D. A. Alter, T. A. Stukel, A. M. Newman, et al. Regional Differences in Process of Care and Outcomes for Older Acute Myocardial Infarction Patients in the United States and Ontario, Canada Circulation, January 16, 2007; 115(2): 196 - 203. [Abstract] [Full Text] [PDF]

				Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]

				E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]