Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores

We determined whether adherence to recommendations for coronary angiography more than 12 h after symptom onset but prior to hospital discharge after a cute myocardial infarction (AMI) resulted in better survival. Using propens ity scores, we created a matched retrospective sample of 19,568 Medicare pa tients hospitalized with AMI during 1994-1995 in the United States. Twenty- nine percent, 36%, and 34% of patients were judged necessary, appropriate, or uncertain, respectively, for angiography while 60% of those judged neces sary received the procedure during the hospitalization. The 3-year survival benefit was largest for patients rated necessary [mean survival difference (95% CI): 17.6% (15.1, 20.1)] and smallest for those rated uncertain [8.8% (6.8, 10.7)]. Angiography recommendations appear to select patients who ar e likely to benefit from the procedure and the consequent interventions. Be cause of the magnitude of the benefit and of the number of patients involve d, steps should be taken to replicate these findings. (C) 2001 Elsevier Sci ence Inc. All rights reserved.