title: Care of acute myocardial infarction by noninvasive and invasive cardiologists: procedure use, cost and outcome.
abstract: OBJECTIVE
  This study sought to determine how noninvasive and invasive cardiologists may differ in the hospital care of patients with acute myocardial infarction.
  
  
  BACKGROUND
  Scant information exists regarding the effect of noninvasive and invasive cardiology subspecialization on invasive cardiac procedural use, cost and outcome in the care of patients with acute myocardial infarction.
  
  
  METHODS
  This study analyzed a prospective cohort of 292 patients admitted to an urban tertiary care hospital from the emergency room under the care of noninvasive or invasive cardiologists. Clinical characteristics; hospital course, including management, utilization of diagnostic coronary angiography and percutaneous transluminal coronary angioplasty; direct hospital costs; length of hospital stay; and post-hospital discharge follow-up data were collected by a prospective data base instrument.
  
  
  RESULTS
  Despite similar clinical characteristics, extent and severity of coronary artery disease and utilization of diagnostic coronary angiography in the two groups of patients, those under the care of an invasive cardiologist were significantly more likely to undergo coronary angioplasty than those under the care of a noninvasive cardiologist. The direct hospital costs and length of stay of the noninvasive and invasive group patients who underwent coronary angioplasty were similar, although overall the direct hospital costs and length of stay were higher for the invasive than for the noninvasive group patients.
  
  
  CONCLUSIONS
  Noninvasive and invasive cardiologists differ in their rate of utilization of coronary angioplasty in similar patients with acute myocardial infarction.
authors.affiliation: Massachusetts General Hospital, Boston 02114, USA.
authors.forename: T T
authors.initials: TT
authors.lastname: Di Salvo
authors.forename: S D
authors.initials: SD
authors.lastname: Paul
authors.forename: D
authors.initials: D
authors.lastname: Lloyd-Jones
authors.forename: A J
authors.initials: AJ
authors.lastname: Smith
authors.forename: G
authors.initials: G
authors.lastname: Villarreal-Levy
authors.forename: V
authors.initials: V
authors.lastname: Bamezai
authors.forename: S I
authors.initials: SI
authors.lastname: Hussain
authors.forename: K A
authors.initials: KA
authors.lastname: Eagle
authors.forename: P T
authors.initials: PT
authors.lastname: O'Gara
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data*; D001900:Boston; D006328:Cardiac Catheterization; D002309:Cardiology / Q000706:statistics & numerical data; D015331:Cohort Studies; D017023:Coronary Angiography / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors