Customize your JAMA Network experience by selecting one or more topics from the list below.
Rosanio S, Tocchi M, Cutler D, et al. Queuing for Coronary Angiography During Severe Supply-Demand Mismatch
in a US Public Hospital
: Analysis of a Waiting List Registry. JAMA. 1999;282(2):145–152. doi:10.1001/jama.282.2.145
Adverse cardiac events have been reported in patients waiting for either
coronary surgery or angioplasty. However, data on the risk of adverse events
while awaiting coronary angiography are limited, and none are available from
a US population.
To quantify cardiac outcomes in patients waiting for elective coronary
Design, Setting, and Participants
Observational cohort study of 381 adult outpatients (mean [SD] age,
55  years; 64% male; 61% white) on a waiting list for coronary angiography
at a US tertiary care public teaching hospital during 1993-1994.
Main Outcome Measures
Rates of cardiac death, nonfatal myocardial infarction, and hospitalizations
for unstable angina or heart failure as a function of amount of time spent
on a waiting list.
Sixty-six patients were dropped from the waiting list but were included
in the study analysis. During a mean (SD) follow-up of 8.4 (6.5) months, cardiac
death, myocardial infarction, and hospitalization occurred in 6 (1.6%), 4
(1.0%), and 26 (6.8%) patients, respectively. The probability of events was
minimal in the first 2 weeks and increased steadily between 3 and 13 weeks.
By Cox multivariate analysis, 2 variables independently identified an increased
risk of adverse events: a strongly positive treadmill exercise electrocardiogram
or positive stress imaging result at referral (odds ratio [OR], 2.32; 95%
confidence interval [CI], 1.22-4.16; P=.01) and the
use of 2 to 3 anti-ischemic medications (OR, 1.98; 95% CI, 1.19-3.96; P=.04). Among 311 patients who ultimately underwent angiography,
those with adverse events had a higher prevalence of coronary disease (96%
vs 60%; P<.001), more frequently required revascularization
(93% vs 53%; P<.001), and had longer hospital
stays (mean [SD], 6.2 [4.3] vs 1.3 [0.7] days; P=.001).
Our data suggest that in a cohort referred for coronary angiography,
delaying the procedure places some patients at risk for death, myocardial
infarction, unplanned hospitalization, a longer hospital stay, and, potentially,
a poorer prognosis. Waits longer than 2 weeks should be avoided, and patients
with strongly positive stress test results and those who require 2 to 3 anti-ischemic
medications should be prioritized for early intervention.
Create a personal account or sign in to: