Differences in use of coronary angiography and outcome of myocardial infarction in Toulouse (France) and Gerona (Spain). The MONICA-Toulouse and REGICOR investigators

Eur Heart J. 2000 May;21(9):740-6. doi: 10.1053/euhj.1999.1858.


Aims: Differences in the management and organization of health services may account for some of the variability in myocardial infarction case fa tality in different geographic areas. The 28-day outcome was compared i n two regions with similar myocardial infarction incidence and mortality rates that had opposing patients in the use of coronary angiography an d 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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cohort Studies
  • Coronary Angiography / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / therapy
  • Myocardial Reperfusion / methods
  • Outcome Assessment, Health Care
  • Registries / statistics & numerical data
  • Spain / epidemiology
  • Survival Rate
  • Time Factors