Likelihood of coronary angiography among First Nations patients with acute myocardial infarction.
BACKGROUND
Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients.


METHODS
Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.


RESULTS
Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85-1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07-1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06-1.80), whereas survival was similar among First Nations and non-First Nations patients who received CABG.


CONCLUSIONS
First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non-First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Lauren C
LC
Bresee
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Merril L
ML
Knudtson
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Jianguo
J
Zhang
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Lynden Lindsay
LL
Crowshoe
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Sofia B
SB
Ahmed
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Marcello
M
Tonelli
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
William A
WA
Ghali
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Hude
H
Quan
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Braden
B
Manns
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Gabriel
G
Fabreau
Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass. brenda.hemmelgarn@albertahealthservices.ca.
Brenda R
BR
Hemmelgarn
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000208:ethnology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors