Comparing invasive and noninvasive management strategies for acute myocardial infarction using administrative databases - 09/08/11
, Christine A. Beck, MD, MSc a, Mark J. Eisenberg, MD, MPH b, Karin Humphries, MBA, DSc c, Lawrence Joseph, PhD a, John R. Penrod, PhD a, Jack V. Tu, MD, PhD dRésumé |
Purpose |
The aim of this study was to compare outcomes after acute myocardial infarction between regions with low and high catheterization access.
Methods |
Observational study using administrative databases of patients with acute myocardial infarction in provinces with low (Ontario) and high (Quebec and British Colombia) access to invasive cardiac procedures (ICP, n = 141718). Using instrumental variables to control for confounding, effectiveness of treatment was measured on 1-year mortality among marginal patients (patients for whom treatment is discretionary and highly dependent on access to ICP).
Results |
The ICP approach was associated with overall decreased mortality (−11%, 95% CI −13% to −8%) with statistically significant reductions in low-access regions (−16%, 95% CI −21% to −10%). High-access regions (QC −8%, 95% CI −19% to 4%) (BC −2%, 95% CI −12% to 7%) exhibited smaller marginal benefits.
Conclusion |
The invasive approach benefits all marginal patients, with greater benefits in regions of lower access, indicating a threshold of availability above which further mortality benefits are negligible.
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Vol 155 - N° 1
P. null - janvier 2008 Retour au numéro
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