Access to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study

GRACE Investigators, Frans Van de Werf, Joel M Gore, Alvaro Avezum, Dietrich C Gulba, Shaun G Goodman, Andrzej Budaj, David Brieger, Kami White, Keith A A Fox, Kim A Eagle, Brian M Kennelly

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To investigate the relation between access to a cardiac catheterisation laboratory and clinical outcomes in patients admitted to hospital with suspected acute coronary syndrome.

DESIGN: Prospective, multinational, observational registry.

SETTING: Patients enrolled in 106 hospitals in 14 countries between April 1999 and March 2003. PARTICIPANTS: 28,825 patients aged > or = 18 years.

MAIN OUTCOME MEASURES: Use of percutaneous coronary intervention or coronary artery bypass graft surgery, death, infarction after discharge, stroke, or major bleeding.

RESULTS: Most patients (77%) across all regions (United States, Europe, Argentina and Brazil, Australia, New Zealand, and Canada) were admitted to hospitals with catheterisation facilities. As expected, the availability of a catheterisation laboratory was associated with more frequent use of percutaneous coronary intervention (41% v 3.9%, P < 0.001) and coronary artery bypass graft (7.1% v 0.7%, P < 0.001). After adjustment for baseline characteristics, medical history, and geographical region there were no significant differences in the risk of early death between patients in hospitals with or without catheterisation facilities (odds ratio 1.13, 95% confidence interval 0.98 to 1.30, for death in hospital; hazard ratio 1.05, 0.93 to 1.18, for death at 30 days). The risk of death at six months was significantly higher in patients first admitted to hospitals with catheterisation facilities (hazard ratio 1.14, 1.03 to 1.26), as was the risk of bleeding complications in hospital (odds ratio 1.94, 1.57 to 2.39) and stroke (odds ratio 1.53, 1.10 to 2.14).

CONCLUSIONS: These findings support the current strategy of directing patients with suspected acute coronary syndrome to the nearest hospital with acute care facilities, irrespective of the availability of a catheterisation laboratory, and argue against early routine transfer of these patients to tertiary care hospitals with interventional facilities.
Original languageEnglish
Pages (from-to)441
JournalBritish Medical Journal (BMJ)
Issue number7489
Publication statusPublished - 26 Feb 2005


  • Aged
  • Cardiac Catheterization
  • Female
  • Health Services Accessibility
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction
  • Myocardial Revascularization
  • Odds Ratio
  • Prognosis
  • Prospective Studies
  • Residence Characteristics
  • Risk Factors


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