PT  - JOURNAL ARTICLE
AU  - Lauren C. Bresee
AU  - Merril L. Knudtson
AU  - Jianguo Zhang
AU  - Lynden (Lindsay) Crowshoe
AU  - Sofia B. Ahmed
AU  - Marcello Tonelli
AU  - William A. Ghali
AU  - Hude Quan
AU  - Braden Manns
AU  - Gabriel Fabreau
AU  - Brenda R. Hemmelgarn
AU  - the Alberta Kidney Disease Network (AKDN)
AU  - the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH)
TI  - Likelihood of coronary angiography among First Nations patients with acute myocardial infarction
AID  - 10.1503/cmaj.131667
DP  - 2014 Jan 01
TA  - Canadian Medical Association Journal
PG  - cmaj.131667
4099  - http://www.cmaj.ca/content/early/2014/05/20/cmaj.131667.short
4100  - http://www.cmaj.ca/content/early/2014/05/20/cmaj.131667.full
AB  - Background: Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non–First Nations patients. Methods: Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non–First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Results: Of the 46 764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62–0.87). Among First Nations and non–First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83–1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85–1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07–1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06–1.80), whereas survival was similar among First Nations and non–First Nations patients who received CABG. Interpretation: First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non–First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.