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(Circulation. 1997;96:1711-1712.)
© 1997 American Heart Association, Inc.

Articles

Does the Presence of an On-site Cardiac Catheterization Facility in a Hospital Alter the Long-term Outcome of Patients Admitted With Acute Myocardial Infarction?

Robert C. Schlant, MD

From the Emory University School of Medicine, Atlanta, Ga.

Correspondence to Robert C. Schlant, MD, Professor of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA 30303. E-mail rschlan@emory.edu

Key Words: Editorials • myocardial infarction • catheterization • mortality

	Introduction

 
In this issue of Circulation, Every et al¹ present an analysis of a longer follow-up to their 1993 analysis² of a registry of patients admitted to 19 hospitals in the Seattle, Wash area for acute myocardial infarction between 1988 and 1994.

As the authors reported in 1993, patients admitted to any of 10 hospitals with on-site cardiac catheterization facilities were more likely to undergo coronary angiography than those admitted to 9 hospitals without such facilities. Transfer for coronary arteriography was quickly and readily accomplished in Seattle. As a result, coronary arteriography was performed in 67% of 7984 patients admitted to hospitals with cardiac catheterization laboratories and in 39% of 4219 patients admitted to hospitals without such laboratories.

Acute reperfusion therapy was performed in 33.9% of patients admitted to hospitals with cardiac catheterization laboratories but in only 23.3% of patients admitted to hospitals without cardiac catheterization laboratories. Unfortunately, it is not possible to determine how many patients were treated by thrombolysis, direct angioplasty, surgery, or more than one technique.

In the present report, the authors conclude that the more conservative approach was not associated with any observed increase in mortality during the period of follow-up, which averaged 2.3 years (maximum follow-up, 6 years). It is of interest, however, that if one considers the subgroup of 4412 patients who presented with ST-segment elevation and who represented only 35.8% of the 12 330 patients, the hospital mortality rate was significantly lower (6.8%) for 3007 patients admitted to hospitals with cardiac catheterization laboratories . . . [Full Text of this Article]