PRIORITY FOR CORONARY-ARTERY SURGERY - WHO GETS BY-PASSED WHEN DEMANDOUTSTRIPS CAPACITY

We investigated the clinical and non-clinical factors which influence the waiting time from initial angiography to bypass surgery, by follow -up of a random sample of 141 patients undergoing their first coronary angiography, for whom a decision to revascularize was made in 1991. T he period between the date of angiography and the date of surgery, and a variety of clinical patient characteristics, were retrieved from me dical notes in mid-1993. Patients were sampled from those investigated in the two Northern Ireland catheterization laboratories in Belfast, both of which were served by one local surgical centre. of the 141 pat ients studied, 86 had had surgery at follow-up. The most important pre dictors of waiting time were: the presence of severe stenosis of the l eft main-stem coronary artery [relative hazards, 3.4 (1.6-7.3)], the p resence of unstable angina at the time of angiography, [relative hazar ds, 2.2 (0.97-5.0)], age at angiography, [relative hazards, 2.2 (1.1-4 .2) for > 65 years vs. < 50 years], having a positive family history o f premature coronary artery disease in a first-degree relative, [relat ive hazards, 1.8 (1.1-2.9)] and smoking habit at angiography, [relativ e hazards 0.6 (0.3-1.1), for current vs. never/ex-smokers]. More weigh t appears to be given to maximizing life extension rather than its qua lity enhancement in determining who gets priority for surgery. The exc eption to this may be in regard to smokers, and purchasers might find it useful to set targets for secondary prevention activities with resp ect to such patients.