INTRODUCTION AND OBJECTIVES: To determine the effect of opening an on-site diagnostic catheterization facility on 30-day and 2-year mortality rates in patients with myocardial infarction (MI). METHODS: The study included 1539 consecutive MI patients aged 25-74 years who were recruited before and after the catheterization laboratory opened in 1998: during 1995-1997 and 1999-2003, respectively. RESULTS: The 641 consecutive MI patients recruited in 1995-1997 had worse 30-day mortality than the 898 recruited between 1999-2003 (11.2% versus 6.35%, respectively; P=.001). The number of coronary angiographies and percutaneous coronary interventions carried out was greater in the second period (19.4% versus 3.3%, and 54.8% versus 23.0%, respectively; P<.001). Two-year survival curves were significantly better in the second period for all-cause and cardiovascular death. The adjusted odds ratio for death at 30 days was 0.58 (95% confidence interval [CI] 0.36-0.95) for the second period compared with the first and the adjusted hazard ratio for cardiovascular death at 2 years for patients still alive at 30 days was 0.62 (95%CI 0.39-0.99). After adjustment for the prescription of statins, angiotensin-converting enzyme inhibitors, beta-blockers and antiplatelet drugs at discharge, the effect observed at 2 years was no longer significant. CONCLUSIONS: Opening a new on-site diagnostic catheterization unit significantly increased the 30-day survival of MI patients. However, the increase in 2-year survival of 30-day survivors observed was largely explained by the implementation of better secondary prevention.
INTRODUCTION AND OBJECTIVES: To determine the effect of opening an on-site diagnostic catheterization facility on 30-day and 2-year mortality rates in patients with myocardial infarction (MI). METHODS: The study included 1539 consecutive MI patients aged 25-74 years who were recruited before and after the catheterization laboratory opened in 1998: during 1995-1997 and 1999-2003, respectively. RESULTS: The 641 consecutive MI patients recruited in 1995-1997 had worse 30-day mortality than the 898 recruited between 1999-2003 (11.2% versus 6.35%, respectively; P=.001). The number of coronary angiographies and percutaneous coronary interventions carried out was greater in the second period (19.4% versus 3.3%, and 54.8% versus 23.0%, respectively; P<.001). Two-year survival curves were significantly better in the second period for all-cause and cardiovascular death. The adjusted odds ratio for death at 30 days was 0.58 (95% confidence interval [CI] 0.36-0.95) for the second period compared with the first and the adjusted hazard ratio for cardiovascular death at 2 years for patients still alive at 30 days was 0.62 (95%CI 0.39-0.99). After adjustment for the prescription of statins, angiotensin-converting enzyme inhibitors, beta-blockers and antiplatelet drugs at discharge, the effect observed at 2 years was no longer significant. CONCLUSIONS: Opening a new on-site diagnostic catheterization unit significantly increased the 30-day survival of MI patients. However, the increase in 2-year survival of 30-day survivors observed was largely explained by the implementation of better secondary prevention.