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April 24, 1995

On-Site Catheterization Laboratory and Prognosis After Acute Myocardial Infarction

Author Affiliations

Assaf Harofeh Hospital; Barzilai Medical Center, Ashkelon; Beilinson Medical Center, Petach Tikvah; Bikur Holim, Jerusalem; Bnei Zion Medical Center, Haifa; Carmel Hospital, Haifa; Carmel Hospital and "Lin" Medical Clinic, Haifa; Central Emek Hospital, Afula; Hadassah, Ein Kerem, Jerusalem; Hadassah, Har Hazofim, Jerusalem; Hasharon Hospital, Petach Tikvah; Hillel Yaffe Hospital, Hadera; Ichilov Hospital, Sourasky Medical Center, Tel Aviv; Josephtal Medical Center, Eilat; Kaplan Hospital, Tehovot; Laniado Hospital, Netanya; Meir Hospital, Kfar Saba; Poriah Hospital, Tiberius; Rambam Medical Center, Haifa; Rivka Ziv Medical Center, Tsfat; Shaare Zedek Medical Center, Jerusalem; Sheba Medical Center, Tel Hashomer; Soroko Medical Center, Beer Sheva; Western Galilee Hospital, Naharia; Wolfson Medical Center, Holon

From the Israeli Thrombolytic Survey Group, Neufeld Cardiac Research Institute Sheba Medical Center, Tel Hashomer, Israel. A complete list of participants in this study appears at the end of this article.

Arch Intern Med. 1995;155(8):813-817. doi:10.1001/archinte.1995.00430080045006

Background:  Since the introduction of thrombolytic therapy for patients with acute myocardial infarction, the use of coronary angiography has substantially increased. We sought to determine whether the presence of on-site coronary angiographic facilities influenced the utilization of coronary procedures in patients with acute myocardial infarction hospitalized in Israel's coronary care units.

Methods:  A prospective survey was conducted in January and February 1992 in the 25 coronary care units operating in Israel, 15 of which had on-site catheterization facilities. Data on demographics, clinical features, thrombolytic therapy, and the type of coronary diagnostic or therapeutic procedures performed during the current in-hospital stay were recorded. Mortality, both in-hospital and 1 year after discharge, was assessed for all patients 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 angiography facilities. Demographic and baseline characteristics were similar in both groups. Thrombolytic therapy was provided equally (46%) to patients admitted to hospital with and without catheterization laboratories. Patients admitted to hospitals with these laboratories underwent coronary angiography (26%) and percutaneous transluminal angioplasty and/or coronary artery bypass grafting (12%) in greater numbers than counterparts 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 patient group admitted to the other hospitals. Patients receiving thrombolytic therapy had similar hospital mortality rates unrelated to the availability of coronary catheterization laboratories.

Conclusion:  This national survey showed that the availability of invasive coronary facilities led to increased use of diagnostic and therapeutic coronary procedures among patients with acute myocardial infarction. There was no difference in hospital or 1-year mortality rates in patients admitted to hospitals with or without on-site coronary angiographic facilities.(Arch Intern Med. 1995;155:813-817)