Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris

Sekhri, Neha; Timmis, Adam; Chen, Ruoling; Junghans, Cornelia; Walsh, Niamh; Zaman, Justin; Eldridge, Sandra; Hemingway, Harry; Feder, Gene
May 2008
BMJ: British Medical Journal (International Edition);5/10/2008, Vol. 336 Issue 7652, p1058
Academic Journal
Objectives To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates. Design Multicentre cohort with five year follow-up. Setting Six ambulatory care clinics in England. Participants 1375 consecutive patients in whom coronary angiography was individually rated as appropriate with the Rand consensus method. Main outcome measures Receipt of angiography (420 procedures); coronary mortality and acute coronary syndrome events. Results In a multivariable analysis, angiography was less likely to be performed in patients aged over 64 compared with those aged under 50 (hazard ratio 0.60, 95% confidence interval 0.38 to 0.96), women compared with men (0.42,0.35 to 0.50), south Asians compared with white people (0.48,0.34 to 0.67), and patients in the most deprived fifth compared with the other four fifths (0.66, 0.40 to 1.08). Not undergoing angiography when it was ¿ deemed appropriate was associated with higher rates of coronary event. Conclusions At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas. Not receiving appropriate angiography was associated with a higher risk of coronary events in all groups. Interventions based on clinical guidance that supports individualised management decisions might improve access and outcomes.


Related Articles

  • Giant single coronary artery with terminal fistulous aneurysm: a rare entity. Adamo, L.; Adamo, M. // Heart;Oct2006, Vol. 92 Issue 10, p1419 

    The article reports on the case of a 28-year-old woman with terminal fistulous aneurysm of a dilated left coronary artery. Coronary angiography showed the presence of a single giant vessel originating from the aortic root. Symptoms of the disease include persistence of exercise induced angina...

  • SINGLE CORONARY ARTERY WITH ISCHEMIA AND SUDDEN CARDIAC ARREST. Kongkiat Chaikriangkrai; Kassi, Mahwash; Polsani, Venkateshwar; Su Min Chang // Methodist DeBakey Cardiovascular Journal;Apr-Jun2014, Vol. 10 Issue 2, p121 

    Single coronary artery (SCA) is a very rare finding. Although most cases of SCA are found incidentally on coronary angiography, it can potentially lead to different clinical repercussions.1, 2 Herein we describe a patient with SCA who had unstable angina with subsequent sudden cardiac arrest,...

  • Prediction of Angiographic Extent of Coronary Artery Disease on the Basis of Clinical Risk Scores in Patients of Unstable Angina. KHANDELWAL, GAURAV; JAIN, ANOOP; RATHORE, MONIKA // Journal of Clinical & Diagnostic Research;Nov2015, Vol. 9 Issue 11, p13 

    Background: The correlation of clinical risk predictors and clinical risk scores: Thrombolysis in Myocardial Infarction (TIMI), Platelet Glycoprotein IIb-IIIa in Unstable Angina, Receptor Suppression Using Integrilin Therapy (PURSUIT) and Global Registry of Acute Coronary Events (GRACE) scores...

  • Exercise Tests in Patients With Severe Angina Pectoris: An Angiographic Correlation. Eshchar, Y.; Yahini, J. H.; Atlas, P.; Kishon, Y.; Deutsch, V.; Neufeld, H. N. // Angiology;Jan1980, Vol. 31 Issue 1, p32 

    Graded submaximal ergometric tests were performed on 60 patients who suffered from clinically severe angina pectoris, and the results were correlated with their coronary angiograms. The test was positive in 44, negative in 9, and undetermined in 7 patients (defined as failure to reach the...

  • Echocardiographic demonstration of multiple coronary artery -- left ventricular microfistulae. Youn, Ho-Joong; Chung, Wook-Sung; Hong, Soon-Jo // Heart;Dec2001, Vol. 86 Issue 6, p671 

    This article illustrates echocardiographic demonstration of multiple coronary artery, left ventricular microfistulae. A 68 year old woman was referred for evaluation of chest pain. The patient had a six month history of typical angina occurring with moderate exertion. She had a 10 year history...

  • Higher Fibrinogen Level is Independently Linked with the Presence and Severity of New-Onset Coronary Atherosclerosis among Han Chinese Population. Zhang, Yan; Zhu, Cheng-Gang; Guo, Yuan-Lin; Xu, Rui-Xia; Li, Sha; Dong, Qian; Li, Jian-Jun // PLoS ONE;Nov2014, Vol. 9 Issue 11, p1 

    Background: Fibrinogen is a coagulation/inflammatory biomarker strongly associated with atherogenesis. However, no data is currently available regarding the association of fibrinogen level with the presence and severity of new-onset coronary atherosclerosis assessed by Gensini score (GS),...

  • Effort angina in a patient with advanced coronary artery disease. Role played by coronary angiography, Ivus and cardiac CT: case report. Zardi, Domenico M.; Zardi, Enrico M.; Berni, Andrea; Nannini, Cristiana; Pace, Biagio Andrea; Santucci, Stefano; Volpe, Massimo // Cardiovascular Ultrasound;2008, Vol. 6, Special section p1 

    Coronary angiography is considered to be the gold standard technique for assessing the severity of obstructive luminal narrowing; however, in a few circumstances it may be misleading. In these cases, cardiac computed tomography (CT) and intravascular ultrasound (IVUS) may help to give a correct...

  • Variations in use of cardiology services in a health authority: Comparison of coronary artery... Payne, Nick; Saul, Carol // BMJ: British Medical Journal (International Edition);1/25/97, Vol. 314 Issue 7076, p257 

    Explores the relation between rates of coronary artery revascularization and prevalence of angina to assess whether use of health services reflects need. Determining prevalence of angina; Prevalence of symptoms and mortality from coronary heart disease compared with deprivation; Proxy measures...

  • Interaction between cigarettes and propranolol in treatment of angina pectoris. Fox, Kim; Jonathan, Anne; Williams, Huw; Selwyn, Andrew // British Medical Journal;7/19/1980, Vol. 281 Issue 6234, p191 

    Focuses on the interaction between cigarettes and propranolol in the treatment of angina pectoris. Effects of smoking in the heart; Effectivity of the treatment for angina pectoris; Signs of myocardial ischaemia.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics