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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

View larger version (21K): [in a new window]   Figure 1 Study flow chart. AMI = acute myocardial infarction.

View larger version (20K): [in a new window]   Figure 2 Cumulative risk of adverse events before and after revascularization. Adverse events are defined as the recurrent cardiac hospitalization (first recurrent admission for angina, myocardial infarction, or congestive heart failure).

View larger version (20K): [in a new window]   Figure 3 Adjusted risk of recurrent cardiac admissions at invasive (vs. non-invasive) hospitals. All models have been adjusted for sociodemographic characteristics, clinical severity, attending physician specialty, and hospital academic affiliation, using Cox proportional hazards. These models adjusted for variations in the use of medical therapies and pertain to patients 65 years of age and older. Medications include the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, HMG-CoA reductase inhibitors, and the absence of calcium-channel blockers at hospital discharge.