title: Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.
abstract: OBJECTIVE
  The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes.
  
  
  BACKGROUND
  The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established.
  
  
  METHODS
  A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias.
  
  
  RESULTS
  Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67).
  
  
  CONCLUSIONS
  The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.
authors.affiliation: Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lupón
authors.forename: V
authors.initials: V
authors.lastname: Valle
authors.forename: J
authors.initials: J
authors.lastname: Marrugat
authors.forename: R
authors.initials: R
authors.lastname: Elosua
authors.forename: L
authors.initials: L
authors.lastname: Serés
authors.forename: M
authors.initials: M
authors.lastname: Pavesi
authors.forename: R
authors.initials: R
authors.lastname: Freixa
authors.forename: G
authors.initials: G
authors.lastname: Sanz
authors.forename: R
authors.initials: R
authors.lastname: Masiá
authors.forename: L
authors.initials: L
authors.lastname: Molina
authors.forename: J
authors.initials: J
authors.lastname: Sala
authors.forename: J
authors.initials: J
authors.lastname: Serra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome