ON-SITE CATHETERIZATION LABORATORY AND PROGNOSIS AFTER ACUTE MYOCARDIAL-INFARCTION

Background: Since the introduction of thrombolytic therapy for patient s with acute myocardial infarction, the use of coronary angiography ha s substantially increased. We sought to determine whether the presence of on-site coronary angiographic facilities influenced the utilizatio n of coronary procedures in patients with acute myocardial infarction hospitalized in Israel's coronary care units. Methods: A prospective s urvey was conducted in January and February 1992 in the 25 coronary ca re units operating in Israel, 15 of which had on-site catheterization facilities. Data on demographics, clinical features, thrombolytic ther apy, and the type of coronary diagnostic or therapeutic procedures per formed during the current in hospital stay were recorded. Mortality, b oth in-hospital and 1 year after discharge, was assessed for all patie nts in the survey. Results: One thousand fourteen consecutive patients with acute myocardial infarction were hospitalized during the survey, 307 (30%) of whom were admitted to 10 coronary care units without and 707 of whom were treated in hospitals with on-site coronary angiograp hy facilities. Demographic and baseline characteristics were similar i n both groups. Thrombolytic therapy was provided equally (46%) to pati ents admitted to hospital with and without catheterization laboratorie s. Patients admitted to hospitals with these laboratories underwent co ronary angiography (26%) and percutaneous transluminal angioplasty and /or coronary artery bypass grafting (12%) in greater numbers than coun terparts admitted to hospitals without such laboratories (10% and 5%, respectively). Hospital and cumulative 1-year mortality rates were 11% and 18%, respectively, in patients admitted to hospitals with on-site catheterization facilities vs 10% and 17%, respectively, in the patie nt group admitted to the other hospitals. Patients receiving thromboly tic therapy had similar hospital mortality rates unrelated to the avai lability of coronary catheterization laboratories. Conclusion: This na tional survey showed that the availability of invasive coronary facili ties led to increased use of diagnostic and therapeutic coronary proce dures among patients with acute myocardial infarction. There was no di fference in hospital or 1-year mortality rates in patients admitted to hospitals with or without on-site coronary angiographic facilities.