Correlates of coronary angiography in patients with stable angina and geographical differences in its utilisation: the ACTION experience.
BACKGROUND
Utilisation of coronary angiography (CAG) varies between different countries. For patients with stable angina, the present study aimed to assess whether such differences could be explained by differences in patient characteristics, and whether these differences were related to outcome.


METHODS
Using data from the ACTION trial, which compared long-acting nifedipine GITS with placebo in 7665 patients with stable angina from 19 countries, we determined by country the ratio of the observed (O) and the expected (E, based on multivariate models) number of patients who had a history of CAG before entry, or underwent CAG during a mean follow-up of 5 years. Similarly, we determined corresponding O/E ratios for the combined occurrence of any death, myocardial infarction (MI) or debilitating stroke (DS) during follow-up.


RESULTS
O/E ratios for a history of CAG before entry ranged from 0.68 [95% confidence interval (CI) 0.60-0.77) for Sweden to 1.43 (95%CI 1.36-1.44) for Belgium, and were significantly correlated (p=0.04) to the corresponding O/E ratios for CAG during follow-up. The combined O/E ratio for CAG either before entry or during follow-up was not correlated (p=0.7) to the O/E for death, MI or DS, which ranged from 0.38 (95%CI undetermined) for Austria to 1.34 (95%CI 0.80-1.89) for France.


CONCLUSIONS
The degree to which CAG is utilised in patients with stable angina varies between countries but is not related to the occurrence of death, MI or stroke. This supports the notion that percutaneous coronary intervention does not reduce the risk of events.
Department of Preventive Medicine, Faculty of Public Health, Medical and Health Sciences Centre, University of Debrecen, Debrecen, Hungary.
Zoltán
Z
Vokó
Nicolas
N
Danchin
Sophie
S
de Brouwer
Bridget-Anne
BA
Kirwan
Philip A
PA
Poole-Wilson
Jacobus
J
Lubsen
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D009543:Nifedipine / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D009543:Nifedipine