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Likelihood of coronary angiography among First Nations patients with acute myocardial infarction.
MedLine Citation:
PMID:  24847149     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients.
METHODS: Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.
RESULTS: Of the 46 764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85-1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07-1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06-1.80), whereas survival was similar among First Nations and non-First Nations patients who received CABG.
INTERPRETATION: First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non-First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
Authors:
Lauren C Bresee; Merril L Knudtson; Jianguo Zhang; Lynden Lindsay Crowshoe; Sofia B Ahmed; Marcello Tonelli; William A Ghali; Hude Quan; Braden Manns; Gabriel Fabreau; Brenda R Hemmelgarn; ;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-20
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  -     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© Canadian Medical Association.
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