| Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada. | |
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MedLine Citation:
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PMID: 9154770 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of cardiac procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. METHODS: We compared the use of invasive cardiac procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. RESULTS: The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P<0.001), and coronary-artery bypass surgery (10.6 percent vs. 1.4 percent, P<0.001) during the first 30 days after the index infarction. These differences in the use of cardiac procedures narrowed but persisted through 180 days of follow-up. The 30-day mortality rates were slightly but significantly lower for the U.S. patients than for the Canadian patients (21.4 percent vs. 22.3 percent, P=0.03). However, the one-year mortality rates were virtually identical (34.3 percent in the United States vs. 34.4 percent in Ontario, P= 0.94). CONCLUSIONS: Short-term mortality after an acute myocardial infarction was slightly lower in the United States than in Ontario, but these differences did not persist through one year of follow-up. The strikingly higher rates of use of cardiac procedures in the United States, as compared with Canada, do not appear to result in better long-term survival rates for elderly U.S. patients with acute myocardial infarction. |
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Authors:
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J V Tu; C L Pashos; C D Naylor; E Chen; S L Normand; J P Newhouse; B J McNeil |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 336 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1997 May |
Date Detail:
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Created Date: 1997-05-22 Completed Date: 1997-05-22 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1500-5 Citation Subset: AIM; IM |
Affiliation:
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Institute for Clinical Evaluative Sciences, North York, ON, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / statistics & numerical data, utilization* Cohort Studies Coronary Angiography / statistics & numerical data, utilization* Coronary Artery Bypass / statistics & numerical data, utilization* Humans Myocardial Infarction / mortality, radiography, therapy* Ontario / epidemiology Physician's Practice Patterns / statistics & numerical data* Survival Rate United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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HS08071/HS/AHRQ HHS |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1997 May 22;336(21):1522-3
[PMID:
9154775
]
N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-9 [PMID: 9312670 ] N Engl J Med. 1997 Oct 2;337(14):1008; author reply 1008-9 [PMID: 9312671 ] N Engl J Med. 2001 Mar 8;344(10):774-5 [PMID: 11236791 ] |
Erratum In:
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N Engl J Med 1997 Jul 10;337(2):139 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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