Likelihood of coronary angiography among First Nations patients with acute myocardial infarction - 10/07/14
for the Alberta Kidney Disease Network (AKDN) and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH)
Contributors: All of the authors contributed to the design of the study. Jianguo Zhang completed the study analysis. Lauren Bresee and Brenda Hemmelgarn drafted the manuscript, which all of the other authors revised. All of the authors approved the final version submitted for publication. Brenda Hemmelgarn had full access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Abstract |
Background |
Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non–First Nations patients.
Methods |
Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non–First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.
Results |
Of the 46 764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62–0.87). Among First Nations and non– First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83–1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85–1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07–1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06–1.80), whereas survival was similar among First Nations and non–First Nations patients who received CABG.
Interpretation |
First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non–First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
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| Competing interests: None declared. This article has been peer reviewed. Funding: This work was supported by a Canadian Institutes of Health Research (CIHR) operating grant and by an interdisciplinary team grant from Alberta Innovates Health Solutions (AIHS). The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) initiative has received contributions from Alberta Health, Merck Frosst Canada Ltd., Monsanto Canada Inc. — Searle division, Eli Lilly Canada Inc., Guidant Corporation, Boston Scientific, Hoffman–LaRoche Ltd., and Johnson & Johnson InCordis. These unrestricted grants provide the project with “general use” funds that support the basic infrastructure of this cardiac registry. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. This study is based in part on data provided by Alberta Health. The interpretation and conclusions are those of the researchers and do not represent the views of the Government of Alberta. At the time of this work, Lauren Bresee was supported by the 4th ICPC/HSFC/CCS (4th International Conference On Preventive Cardiology/Heart and Stroke Foundation of Canada/Canadian Cardiovascular Society) Fellowship in Preventive Cardiology and a fellowship award from AIHS. Brenda Hemmelgarn, Sofia Ahmed, William Ghali, Merril Knudtson, Braden Manns and Marcello Tonelli are supported by a joint initiative between Alberta Health and the Universities of Alberta and Calgary. Brenda Hemmelgarn is supported by the Roy and Vi Baay Chair in Kidney Research. Sofia Ahmed is supported by AIHS and CIHR. Hude Quan is supported by AIHS. |
Vol 186 - N° 10
P. E372-E380 - juillet 2014 Retour au numéro
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