WAITING FOR CORONARY REVASCULARIZATION - A COMPARISON BETWEEN NEW-YORK-STATE, THE NETHERLANDS AND SWEDEN

Objective: To compare waiting times for percutaneous transluminal coro nary angioplasty (PTCA) and coronary artery bypass graft (CABG) surger y in New York State, the Netherlands and Sweden and to determine wheth er queuing adversely affects patients' health. Methods: We reviewed th e medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measu red the median waiting time between coronary angiography and PTCA or C ABG. Results: The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sw eden (P<0.001). For CABG, New York patients waited 17 days, while Dutc h and Swedish patients waited 72 and 59 days, respectively (P<0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG ca ndidates and 0.15% for PTCA candidates. Conclusions: There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experi encing an adverse event. In both the Netherlands and Sweden, the capac ity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other are as where quality of care can be improved. (C) 1997 Elsevier Science Ir eland Ltd.