USE OF CORONARY ANGIOGRAPHY AND REVASCULARIZATION PROCEDURES FOLLOWING ACUTE MYOCARDIAL-INFARCTION - A EUROPEAN PERSPECTIVE

Aims There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myo cardial infarction. Large differences in the uptake of these procedure s have been reported but representative data are scarce. Outcome studi es have produced opposing conclusions concerning the impact of the hig h rate of these cardiac procedures. Methods and Results A. population- based patient sampling approach was utilized to identify routine pract ice in representative samples from 11 European countries. Data were co llected retrospectively on treatment in the 6 months following acute m yocardial infarction (n=2807). There was wide variation in utilization of coronary angiography and revascularization procedures. Even after restricting the analysis to patients <65 years (n=1262), there remaine d a 6-13 fold variation in the use of these procedures. A decreased li kelihood of undergoing these procedures was associated with elder age. In addition, there was an independent and negative association betwee n female sex and utilization of coronary angiography and coronary arte ry bypass grafting (CABG). Conclusion The effect on patient outcome of the observed variation in use of these procedures is not known but ha s important cost and resource implications for the health services. Ou tcome research is needed to define patient selection criteria and to m easure the cost-utility of different angiography and revascularization rates.