Predictors of same-admission cardiac catheterization in patients with acute ischemic syndromes.
BACKGROUND
Various strategies exist for the use of cardiac catheterization in unstable angina or non-Q wave myocardial infarction. At the authors' institution, the overall volume of cardiac catheterization has increased in recent years.


OBJECTIVE
To investigate whether this increased volume of cardiac catheterization was due to adoption of a more invasive approach to the management of patients with acute ischemic syndromes.


METHODS
A retrospective cohort study was conducted using detailed chart review of coronary care unit admissions during 1990/91 and 1993/94.


METHODS
A university-affiliated tertiary care referral centre with facilities for cardiac catheterization.


METHODS
One hundred patients randomly selected from among those with unstable angina, non-Q wave myocardial infarction or chest pain not yet diagnosed in each of the study years. Detailed follow-up was complete for all patients.


METHODS
The use of cardiac catheterization during the index admission was documented.


RESULTS
There was a trend towards more frequent use of same admission cardiac catheterization in the later period (21% [CI 14% to 31%] versus 12% [CI 7% to 20%], P = 0.09). However, after controlling for baseline characteristics and in-hospital events, the year of admission did not independently predict the use of catheterization (P = 0.60). By multivariate logistic regression, recurrence of chest pain and evidence of myocardial necrosis were most closely associated with same-admission cardiac catheterization.


CONCLUSIONS
Although clinical factors partially explain the increased use of catheterization over time, there may have also been shift towards a more aggressive practice style at the authors' institution. Further study is needed to address this possibility.
Kassam
S
S
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario.
Freskiw
K
K
Sykora
K
K
Morgan
C D
CD
Cohen
E A
EA
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D017202:Myocardial Ischemia / Q000175:diagnosis*; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies