RT Journal Article
SR Electronic
T1 Likelihood of coronary angiography among First Nations patients with acute myocardial infarction
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E372
OP E380
DO 10.1503/cmaj.131667
VO 186
IS 10
A1 Lauren C. Bresee
A1 Merril L. Knudtson
A1 Jianguo Zhang
A1 Lynden (Lindsay) Crowshoe
A1 Sofia B. Ahmed
A1 Marcello Tonelli
A1 William A. Ghali
A1 Hude Quan
A1 Braden Manns
A1 Gabriel Fabreau
A1 Brenda R. Hemmelgarn
A1 ,
YR 2014
UL http://www.cmaj.ca/content/186/10/E372.abstract
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.