Every N R, Larson E B, Litwin P E, Maynard C, Fihn S D, Eisenberg M S, Hallstrom A P, Martin J S, Weaver W D
Northwest Health Services Research and Development Field Program, Seattle Veterans Affairs Medical Center, WA.
N Engl J Med. 1993 Aug 19;329(8):546-51. doi: 10.1056/NEJM199308193290807.
During the past decade the use of coronary angiography after acute myocardial infarction has substantially increased. Among the possible contributing factors, the increasing availability of cardiac catheterization facilities was the focus of our investigation.
We investigated whether the availability of cardiac catheterization facilities at an admitting hospital was associated with the likelihood that a patient would undergo coronary angiography. After adjusting for age, sex, cardiac history, and cardiac complications during hospitalization, we evaluated this association in 5867 consecutive patients with acute myocardial infarction admitted to 19 Seattle-area hospitals. We also assessed the association between the presence of on-site cardiac catheterization facilities and in-hospital mortality.
Patients admitted to hospitals with on-site cardiac catheterization facilities were far more likely to undergo coronary angiography (odds ratio, 3.21; 95 percent confidence interval, 2.81 to 3.67) than patients admitted to hospitals where transfer to another institution would be required to perform cardiac catheterization. Admission to a hospital with on-site facilities was more strongly associated with the use of coronary angiography than any characteristic of the patient. Although our study had limited power to detect differences in mortality, the availability of coronary angiography had no discernible association with in-hospital mortality rates (odds ratio for mortality among patients admitted to hospitals with on-site facilities vs. patients admitted to hospitals without such facilities, 0.88; 95 percent confidence interval, 0.71 to 1.09).
In this community-wide study, the availability of on-site cardiac catheterization facilities was associated with a higher likelihood that a patient would undergo coronary angiography. However, admission to hospitals with these facilities did not appear to be associated with lower short-term mortality.
在过去十年中，急性心肌梗死后冠状动脉造影的使用大幅增加。在可能的促成因素中，心脏导管检查设施可用性的增加是我们研究的重点。
我们调查了收治医院心脏导管检查设施的可用性是否与患者接受冠状动脉造影的可能性相关。在对年龄、性别、心脏病史和住院期间的心脏并发症进行调整后，我们评估了19家西雅图地区医院连续收治的5867例急性心肌梗死患者之间的这种关联。我们还评估了现场心脏导管检查设施的存在与住院死亡率之间的关联。
与需要转至另一机构进行心脏导管检查的医院收治的患者相比，收治于有现场心脏导管检查设施医院的患者接受冠状动脉造影的可能性要高得多（优势比为3.21；95%置信区间为2.81至3.67）。与患者的任何特征相比，收治于有现场设施的医院与冠状动脉造影的使用关联更强。尽管我们的研究检测死亡率差异的能力有限，但冠状动脉造影的可用性与住院死亡率没有明显关联（有现场设施医院收治的患者与无此类设施医院收治的患者的死亡率优势比为0.88；95%置信区间为0.71至1.09）。
在这项全社区范围的研究中，现场心脏导管检查设施的可用性与患者接受冠状动脉造影的较高可能性相关。然而，收治于有这些设施的医院似乎与较低的短期死亡率无关。
