Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation
There are wide variations between countries in the use of invasive cardiac catheterisation and revascularisation procedures for patients with acute ischaemic syndromes. We studied the relation between rates of such procedures and rates of cardiovascular death, myocardial infarction, stroke, refracto...
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| Veröffentlicht in: | The Lancet (British edition) 1998-08, Vol.352 (9127), p.507-514 |
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| creator | Yusuf, Salim Flather, Marcus Pogue, Janice Hunt, David Varigos, John Piegas, Leopoldo Avezum, Alvaro Anderson, Jeffrey Keltai, Matyas Budaj, Andrzej Fox, Keith Ceremuzynski, Leszek |
| description | There are wide variations between countries in the use of invasive cardiac catheterisation and revascularisation procedures for patients with acute ischaemic syndromes. We studied the relation between rates of such procedures and rates of cardiovascular death, myocardial infarction, stroke, refractory angina, and major bleeding in a prospective, registry-based study in six countries with widely varying intervention rates.
7987 consecutive patients presenting with unstable angina or suspected myocardial infarction without ST-segment elevation were recruited prospectively from 95 hospitals in six countries and followed up for 6 months.
The rates of all procedures were highest in patients in Brazil and the USA, intermediate in Canada and Australia, and lowest in Hungary and Poland. There were no significant differences in rates of cardiovascular death or myocardial infarction among these countries (4·7% overall [range 3·7-5·6] at 7 days; 11% overall [9-12] at 6 months). For the countries with the highest rates of invasive procedures (59%) versus the rest (21%) there was no difference in rate of cardiovascular death or myocardial infarction (adjusted odds ratio 0·88 at 7 days and 1·0 at 6 months). Rates of stroke were higher in Brazil and the USA than in the countries with lower intervention rates (adjusted odds ratio at 7 days 3·0, p=0·012; at 6 months 1·8, p=0·004) but rates of refractory angina at 7 days (0·7, p |
| doi_str_mv | 10.1016/S0140-6736(97)11162-X |
| format | Article |
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7987 consecutive patients presenting with unstable angina or suspected myocardial infarction without ST-segment elevation were recruited prospectively from 95 hospitals in six countries and followed up for 6 months.
The rates of all procedures were highest in patients in Brazil and the USA, intermediate in Canada and Australia, and lowest in Hungary and Poland. There were no significant differences in rates of cardiovascular death or myocardial infarction among these countries (4·7% overall [range 3·7-5·6] at 7 days; 11% overall [9-12] at 6 months). For the countries with the highest rates of invasive procedures (59%) versus the rest (21%) there was no difference in rate of cardiovascular death or myocardial infarction (adjusted odds ratio 0·88 at 7 days and 1·0 at 6 months). Rates of stroke were higher in Brazil and the USA than in the countries with lower intervention rates (adjusted odds ratio at 7 days 3·0, p=0·012; at 6 months 1·8, p=0·004) but rates of refractory angina at 7 days (0·7, p<0·001) and readmission for unstable angina at 6 months were lower (0·70, 0·63; both p<0·001). Comparison of results for hospitals without cardiac-catheterisation facilities and for those with such facilities gave adjusted odds ratios for cardiovascular death, myocardial infarction, or stroke at 6 months of 0·83 (10·6%
vs 12·5%, p=0·05) and for refractory angina of 1·25 (19·3%
vs 16·1%, p=0·09).
Higher rates of invasive and revascularisation procedures were associated with lower rates of refractory angina or readmission for unstable angina, no apparent reducton in cardiovascular death or myocardial infarction, but with higher rates of stroke. Randomised trials should assess the relative impact of conservative and more aggressive approaches to invasive cardiac procedures and revascularisations in patients with unstable angina.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(97)11162-X</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Angina pectoris ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Heart ; Heart attacks ; Hospitals ; Medical procedures ; Medical sciences ; Mortality ; Myocardial infarction ; Myocarditis. Cardiomyopathies</subject><ispartof>The Lancet (British edition), 1998-08, Vol.352 (9127), p.507-514</ispartof><rights>1998 Elsevier Ltd</rights><rights>1998 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Aug 15, 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-5c998278e31f0a95347d557e950c9a5017cd18adcad02ecc76379fccc418cabb3</citedby><cites>FETCH-LOGICAL-c415t-5c998278e31f0a95347d557e950c9a5017cd18adcad02ecc76379fccc418cabb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/199036385?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2353307$$DView record in Pascal Francis$$Hfree_for_read</backlink></links><search><creatorcontrib>Yusuf, Salim</creatorcontrib><creatorcontrib>Flather, Marcus</creatorcontrib><creatorcontrib>Pogue, Janice</creatorcontrib><creatorcontrib>Hunt, David</creatorcontrib><creatorcontrib>Varigos, John</creatorcontrib><creatorcontrib>Piegas, Leopoldo</creatorcontrib><creatorcontrib>Avezum, Alvaro</creatorcontrib><creatorcontrib>Anderson, Jeffrey</creatorcontrib><creatorcontrib>Keltai, Matyas</creatorcontrib><creatorcontrib>Budaj, Andrzej</creatorcontrib><creatorcontrib>Fox, Keith</creatorcontrib><creatorcontrib>Ceremuzynski, Leszek</creatorcontrib><creatorcontrib>for the OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators</creatorcontrib><title>Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation</title><title>The Lancet (British edition)</title><description>There are wide variations between countries in the use of invasive cardiac catheterisation and revascularisation procedures for patients with acute ischaemic syndromes. We studied the relation between rates of such procedures and rates of cardiovascular death, myocardial infarction, stroke, refractory angina, and major bleeding in a prospective, registry-based study in six countries with widely varying intervention rates.
7987 consecutive patients presenting with unstable angina or suspected myocardial infarction without ST-segment elevation were recruited prospectively from 95 hospitals in six countries and followed up for 6 months.
The rates of all procedures were highest in patients in Brazil and the USA, intermediate in Canada and Australia, and lowest in Hungary and Poland. There were no significant differences in rates of cardiovascular death or myocardial infarction among these countries (4·7% overall [range 3·7-5·6] at 7 days; 11% overall [9-12] at 6 months). For the countries with the highest rates of invasive procedures (59%) versus the rest (21%) there was no difference in rate of cardiovascular death or myocardial infarction (adjusted odds ratio 0·88 at 7 days and 1·0 at 6 months). Rates of stroke were higher in Brazil and the USA than in the countries with lower intervention rates (adjusted odds ratio at 7 days 3·0, p=0·012; at 6 months 1·8, p=0·004) but rates of refractory angina at 7 days (0·7, p<0·001) and readmission for unstable angina at 6 months were lower (0·70, 0·63; both p<0·001). Comparison of results for hospitals without cardiac-catheterisation facilities and for those with such facilities gave adjusted odds ratios for cardiovascular death, myocardial infarction, or stroke at 6 months of 0·83 (10·6%
vs 12·5%, p=0·05) and for refractory angina of 1·25 (19·3%
vs 16·1%, p=0·09).
Higher rates of invasive and revascularisation procedures were associated with lower rates of refractory angina or readmission for unstable angina, no apparent reducton in cardiovascular death or myocardial infarction, but with higher rates of stroke. Randomised trials should assess the relative impact of conservative and more aggressive approaches to invasive cardiac procedures and revascularisations in patients with unstable angina.</description><subject>Angina pectoris</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Medical procedures</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocarditis. 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Vascular system</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Medical procedures</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Myocarditis. 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Leopoldo</au><au>Avezum, Alvaro</au><au>Anderson, Jeffrey</au><au>Keltai, Matyas</au><au>Budaj, Andrzej</au><au>Fox, Keith</au><au>Ceremuzynski, Leszek</au><aucorp>for the OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation</atitle><jtitle>The Lancet (British edition)</jtitle><date>1998-08-15</date><risdate>1998</risdate><volume>352</volume><issue>9127</issue><spage>507</spage><epage>514</epage><pages>507-514</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>There are wide variations between countries in the use of invasive cardiac catheterisation and revascularisation procedures for patients with acute ischaemic syndromes. We studied the relation between rates of such procedures and rates of cardiovascular death, myocardial infarction, stroke, refractory angina, and major bleeding in a prospective, registry-based study in six countries with widely varying intervention rates.
7987 consecutive patients presenting with unstable angina or suspected myocardial infarction without ST-segment elevation were recruited prospectively from 95 hospitals in six countries and followed up for 6 months.
The rates of all procedures were highest in patients in Brazil and the USA, intermediate in Canada and Australia, and lowest in Hungary and Poland. There were no significant differences in rates of cardiovascular death or myocardial infarction among these countries (4·7% overall [range 3·7-5·6] at 7 days; 11% overall [9-12] at 6 months). For the countries with the highest rates of invasive procedures (59%) versus the rest (21%) there was no difference in rate of cardiovascular death or myocardial infarction (adjusted odds ratio 0·88 at 7 days and 1·0 at 6 months). Rates of stroke were higher in Brazil and the USA than in the countries with lower intervention rates (adjusted odds ratio at 7 days 3·0, p=0·012; at 6 months 1·8, p=0·004) but rates of refractory angina at 7 days (0·7, p<0·001) and readmission for unstable angina at 6 months were lower (0·70, 0·63; both p<0·001). Comparison of results for hospitals without cardiac-catheterisation facilities and for those with such facilities gave adjusted odds ratios for cardiovascular death, myocardial infarction, or stroke at 6 months of 0·83 (10·6%
vs 12·5%, p=0·05) and for refractory angina of 1·25 (19·3%
vs 16·1%, p=0·09).
Higher rates of invasive and revascularisation procedures were associated with lower rates of refractory angina or readmission for unstable angina, no apparent reducton in cardiovascular death or myocardial infarction, but with higher rates of stroke. Randomised trials should assess the relative impact of conservative and more aggressive approaches to invasive cardiac procedures and revascularisations in patients with unstable angina.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><doi>10.1016/S0140-6736(97)11162-X</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | The Lancet (British edition), 1998-08, Vol.352 (9127), p.507-514 |
| issn | 0140-6736 1474-547X |
| language | eng |
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| source | EBSCOhost Business Source Complete; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Angina pectoris Biological and medical sciences Cardiology Cardiology. Vascular system Heart Heart attacks Hospitals Medical procedures Medical sciences Mortality Myocardial infarction Myocarditis. Cardiomyopathies |
| title | Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation |
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