PREDICTORS OF SAME-ADMISSION CARDIAC-CATHETERIZATION IN PATIENTS WITHACUTE ISCHEMIC SYNDROMES

BACKGROUND: Various strategies exist for the use of cardiac catheteriz ation in unstable angina or non-Q wave myocardial infarction. At the a uthors' institution, the overall volume of cardiac catheterization has increased in recent years. OBJECTIVE: To investigate whether this inc reased volume of cardiac catheterization was due to adoption of a more invasive approach to the management of patients with acute ischemic s yndromes. DESIGN: A retrospective cohort study was conducted using det ailed chart review of coronary care unit admissions during 1990/91 and 1993/94. SETTING: A university-affiliated tertiary care referral cent re with facilities for cardiac catheterization. PATIENTS: One hundred patients randomly selected from among those with unstable angina, non- Q wave myocardial infarction or chest pain not yet diagnosed in each o f the study years. Detailed follow-up was complete for all patients. O UTCOME MEASURE: The use of cardiac catheterization during the index ad mission was documented. MAIN RESULTS: There was a trend towards more f requent use of same-admission cardiac catheterization in the later per iod (21% [CI 14% to 31%] versus 12% [CI 7% to 20%], P=0.09). However, after controlling for baseline characteristics and in-hospital events, the year of admission did not independently predict the use of cathet erization (P=0.60). By multivariate logistic regression, recurrence of chest: pain and evidence of myocardial necrosis were most closely ass ociated with same-admission cardiac catheterization. CONCLUSIONS: Alth ough clinical factors partially explain the increased use of catheteri zation over time, there may have also been a shift towards a more aggr essive practice style at the authors institution. Further study is nee ded to address this possibility.