title: Differences in use of coronary angiography and outcome of myocardial infarction in Toulouse (France) and Gerona (Spain). The MONICA-Toulouse and REGICOR investigators.
abstract: OBJECTIVE
  Differences in the management and organization of health services may account for some of the variability in myocardial infarction case fa tality in different geographic areas. The 28-day outcome was compared i n two regions with similar myocardial infarction incidence and mortality rates that had opposing patients in the use of coronary angiography an d coronary revascularization.
  
  
  RESULTS
  The 28-day case fatality of patients aged 35 to 64 years with myocardial infarction, surviving the first hour post-admission to hospitals with coronary care units, was compared in the population of myocardial infarction registries of Toulouse, France and Gerona, Spain. Patient characteristics were similar. In Toulouse, 93% of the 819 registered patients underwent coronary angiography compared with only 6% of the 454 in Gerona. Among hospitalized patients 28-day case fatality was 4.3% and 9.3% in Toulouse and Gerona, respectively (P=0.0003). Rates of thrombolysis and beta-blocker use were higher in Toulouse, although severity indicators were similar to those of Gerona. A model adjusted for these variables showed that the risk of death was 1.90 (95% confidence interval: 1.17-3.07) in Gerona patients compared with those of Toulouse.
  
  
  CONCLUSIONS
  Routine angiography use is associated with better 28-day myocardial infarction prognosis than restrictive use. However, the optimum proportion of myocardial infarction patients who have to receive angiography procedures remains unclear.
authors.affiliation: Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Marrugat
authors.forename: J
authors.initials: J
authors.lastname: Ferrières
authors.forename: R
authors.initials: R
authors.lastname: Masià
authors.forename: J
authors.initials: J
authors.lastname: Ruidavets
authors.forename: J
authors.initials: J
authors.lastname: Sala
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D017063:Outcome Assessment, Health Care; D012042:Registries / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors