Document Detail

Paradoxical use of invasive cardiac procedures for patients with non-ST segment elevation myocardial infarction: an international perspective from the CRUSADE Initiative and the Canadian ACS Registries I and II.
MedLine Citation:
PMID:  17985010     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Practice guidelines support an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes, particularly in those at higher risk. OBJECTIVES: To compare North American rates of invasive cardiac procedure use stratified by risk. METHODS: Use of invasive cardiac procedures and other care patterns in patients with non-ST segment elevation acute coronary syndromes from the United States (US) Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) National Quality Improvement Initiative (n=88,097; 465 hospitals) and Canadian ACS Registries I (n=1270; 51 hospitals) and II (n=1473; 36 hospitals) were compared after dividing patients into different risk categories based on predicted risk of in-hospital mortality. RESULTS: While the overall use of invasive procedures was higher in the US, high-risk patients were least likely to undergo coronary angiography (41% versus 64% in Canada [P<0.0001] and 53% versus 76% in the United States [P<0.0001]) and percutaneous coronary intervention (14% versus 32% in Canada [P<0.0001] and 28% versus 51% in the US [P<0.0001]) compared with low-risk patients in both countries, and had longer median waiting times for these procedures (120 h versus 96 h in Canada [P<0.0001] and 34 h versus 23 h in the US [P<0.0001] for coronary angiography). CONCLUSIONS: The inverse relationship between risk level and the use of invasive cardiac procedures for patients in the US and Canada suggests that a risk stratification-guided approach for triaging patients to an early invasive management strategy is paradoxically used. This incongruous relationship holds true regardless of resource availability or overall rates of cardiac catheterization.
Mohammad I Zia; Shaun G Goodman; Eric D Peterson; Jyotsna Mulgund; Anita Y Chen; Anatoly Langer; Mary Tan; E Magnus Ohman; W Brian Gibler; Charles V Pollack; Matthew T Roe
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  23     ISSN:  0828-282X     ISO Abbreviation:  Can J Cardiol     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-06     Completed Date:  2007-12-21     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1073-9     Citation Subset:  IM    
Canadian Heart Research Centre, Toronto, Canada.
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MeSH Terms
Acute Coronary Syndrome / diagnosis
Angina, Unstable / diagnosis,  drug therapy,  surgery*
Angioplasty, Transluminal, Percutaneous Coronary / utilization
Guideline Adherence
Heart Catheterization / utilization
Middle Aged
Myocardial Infarction / diagnosis,  drug therapy,  surgery*
Practice Guidelines as Topic
Risk Assessment
Risk Factors
Time Factors
United States
Comment In:
Can J Cardiol. 2007 Nov;23(13):1080-1   [PMID:  17985011 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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