Invasive procedures, often given to patients as soon as they are admitted to hospital with a life-threatening heart condition, do not necessarily improve survival, finds a study published on bmj.com today.
The researchers recommend more selective use of procedures, and argue against early routine transfer of patients to hospitals with specialist facilities.
The study involved over 28,000 patients in 14 countries who were admitted to hospital with suspected acute coronary syndrome between April 1999 and March 2003.
Most patients (77%) were admitted to hospitals with cardiac catheterisation facilities (a procedure in which a fine catheter (tube) is introduced into the heart via a blood vessel, to investigate its condition).
As expected, patients admitted to hospitals with specialist facilities underwent more invasive procedures than patients first admitted to hospitals without facilities.
However, after adjusting for other factors, the risk of death at six months was 14% higher among patients first admitted to hospitals with specialist facilities. The risk of major bleeding and stroke in hospital was also higher.
These results do not suggest that an invasive approach to patients with acute coronary syndrome is harmful but that a more restrictive selective use of invasive procedures is at least as effective as a more liberal routine use, say the authors.
This analysis therefore supports the current strategy of admitting patients with acute coronary syndrome as rapidly as possible to the nearest hospital, irrespective of the availability of a catheterisation laboratory, and argues against the early routine transfer of these patients to a specialised hospital with interventional facilities.
Frans Van de Werf, Chairman, Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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