VARIATION IN THE USE OF CORONARY ANGIOGRAPHY IN PATIENTS WITH UNSTABLE ANGINA IS RELATED TO DIFFERENCES IN PATIENT POPULATION AND AVAILABILITY OF ANGIOGRAPHY FACILITIES, WITHOUT AFFECTING PROGNOSIS

Objectives Examination of the difference in management strategies with respect to coronary angiography in patients with unstable angina pect oris, and the consequences of this difference on prognosis. Design Pro spective registration of consecutive patients admitted to two differen t hospitals. Setting University and a large community hospital in Rott erdam, the Netherlands. Subjects Patients under 80 years, without rece nt (<4 weeks) infarction or recent (<6 months) coronary revascularizat ion procedure, admitted for chest pain suspected to indicate unstable angina pectoris. Main outcome measures Decision to initiate coronary a ngiography or to continue on medical treatment. At 6 months the occurr ence of death and myocardial infarction was measured. Results Clinical variables associated with the decision to initiate angiography were y oung age, male gender, progression of angina, multiple pain episodes a nd use of beta-blocker or calcium antagonists before admission, abnorm al ST-T segment on baseline EGG, recurrent pain in hospital, and ECG c hanges during pain. These associations did not differ between hospital s. Nevertheless, angiography was performed more often in the presence of angiography facilities (university hospital), independent of the va riable case-mix. Survival and infarct-free survival were similar in bo th hospitals, 96% and 90% respectively. Conclusion The difference in a ngiography rate for unstable angina can be explained in part by differ ences in patient population and hospital facilities, but no difference was observed in physicians' assessment of patient characteristics. Th e observed practice variation did not affect prognosis.