Hospital Revascularization Rate Not an Important Factor in Outcome After AMI

Long-term outcome after acute myocardial infarction (AMI) is influenced by whether a patient is cared for a teaching hospital, but not by the hospital’s rate of revascularization procedures, according to a report published today in the April 25th issue of The Journal of the American Medical Association.

“A lot of studies have compared rates of cardiac procedures between different hospital settings, and we have inferred that the outcome differences between these hospitals are attributable to differences in revascularization procedure rates alone,” Dr. David A. Alter, from the Institute for Clinical Evaluative Sciences in Toronto, noted in an interview with Reuters Health.

“But we have made this inference without considering the multitude of other competing factors that may be driving outcome differences,” he said.

Dr. Alter and colleagues looked at the 5-year outcomes of 25,697 AMI patients who presented at hospitals in Ontario, including those that did not have revascularization facilities. As expected, they found that patients at hospitals with high rates of angiography, angioplasty and bypass surgery had better long-term outcomes.

“However, the differences in outcomes had nothing to do with differences in the rates of revascularization procedures themselves,” Dr. Alter said. “In fact, it was the teaching status of the hospital that improved outcomes.” The key to improved outcomes, he explained, is that teaching hospitals make better use of evidence-based therapy after discharge, compared with non-teaching hospitals, and offer more intensive followup care.

“As physicians we have placed too much emphasis on the effectiveness of revascularization procedures. [Although] they are important for some patients, they really do not make a large difference in the overall population of MI patients,” Dr. Alter told Reuters Health.

“We have to look beyond procedures,” he stressed. “The use of evidence-based therapies, the intensity, and followup care are perhaps as important, if not more important, than revascularization procedures themselves in driving differences in outcomes.”

JAMA 2001;285:2101-2108.