Differences in use of coronary angiography and outcome of myocardial infarction in Toulouse (France) and Gerona (Spain)

Aims Differences in the management and organization of health services may account for some of the variability in myocardial infarction case fatality in different geographic areas. The 28-day outcome was compared in two regions with similar myocardial infarction incidence and mortality rates that had opposing patterns in the use of coronary angiography and coronary revascularization. Methods and 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.