van Miltenburg-van Zijl A J, Simoons M L, Bossuyt P M, Taylor T R, Veerhoek M J
Thoraxcenter, Erasmus University Rotterdam, The Netherlands.
Eur Heart J. 1996 Dec;17(12):1828-35. doi: 10.1093/oxfordjournals.eurheartj.a014799.
Examination of the difference in management strategies with respect to coronary angiography in patients with unstable angina pectoris, and the consequences of this difference on prognosis.
Prospective registration of consecutive patients admitted to two different hospitals.
University and a large community hospital in Rotterdam, the Netherlands.
Patients under 80 years, without recent (< 4 weeks) infarction or recent (< 6 months) coronary revascularization procedure, admitted for chest pain suspected to indicate unstable angina pectoris.
Decision to initiate coronary angiography or to continue on medical treatment. At 6 months the occurrence of death and myocardial infarction was measured.
Clinical variables associated with the decision to initiate angiography were young age, male gender, progression of angina, multiple pain episodes and use of beta-blocker or calcium antagonists before admission, abnormal ST-T segment on baseline ECG, recurrent pain in hospital, and ECG changes during pain. These associations did not differ between hospitals. Nevertheless, angiography was performed more often in the presence of angiography facilities (university hospital), independent of the variable case-mix. Survival and infarct-free survival were similar in both hospitals, 96% and 90% respectively.
The difference in angiography rate for unstable angina can be explained in part by differences in patient population and hospital facilities, but no difference was observed in physicians' assessment of patient characteristics. The observed practice variation did not affect prognosis.
研究不稳定型心绞痛患者在冠状动脉造影管理策略上的差异，以及这种差异对预后的影响。
对两所不同医院收治的连续患者进行前瞻性登记。
荷兰鹿特丹的一所大学医院和一所大型社区医院。
80岁以下、近期（<4周）无梗死或近期（<6个月）无冠状动脉血运重建术、因疑似不稳定型心绞痛的胸痛入院的患者。
决定启动冠状动脉造影或继续药物治疗。在6个月时，测量死亡和心肌梗死的发生率。
与决定启动造影相关的临床变量包括年轻、男性、心绞痛进展、多次疼痛发作、入院前使用β受体阻滞剂或钙拮抗剂、基线心电图ST-T段异常、住院期间反复疼痛以及疼痛时的心电图变化。这些关联在两所医院之间没有差异。然而，在有造影设备的医院（大学医院）进行造影的频率更高，与病例组合变量无关。两所医院的生存率和无梗死生存率相似，分别为96%和90%。
不稳定型心绞痛造影率的差异部分可由患者人群和医院设施的差异来解释，但医生对患者特征的评估没有差异。观察到的实践差异并未影响预后。
