Hvelplund, Anders

Galatius, Søren

Madsen, Mette

Rasmussen, Jeppe Nørgaard

Rasmussen, Søren

Madsen, Jan Kyst

Abildstrøm, Steen Zabell

University of Southern Denmark Research Output

Syddansk Universitet
Lower rate of invasive revascularisation after coronary angiography, following acute
coronary syndrome, the longer distance you live from an invasive centres
Hvelplund, Anders; Galatius, Søren; Madsen, Mette; Rasmussen, Jeppe Nørgaard;
Rasmussen, Søren; Madsen, Jan Kyst; Abildstrøm, Steen Zabell
Publication date:
2009
Document Version
Publisher's PDF, also known as Version of record
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Citation for pulished version (APA):
Hvelplund, A., Galatius, S., Madsen, M., Rasmussen, J. N., Rasmussen, S., Madsen, J. K., & Abildstrøm, S. Z.
(2009). Lower rate of invasive revascularisation after coronary angiography, following acute coronary syndrome,
the longer distance you live from an invasive centres. Poster session presented at ESC09 - Official congress of
the European Congress of Cardiology, Barcelona, Spain.
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Download date: 12. Jan. 2017
5 
invasive 
centres
9  assisting 
subacute 
CAG centres
48 other 
hospitals
We identified 24 910 patients With ACS (83.5%  with myocardial 
infarction). 
Of those patients 1/3 lived less than 21 kilometres from an 
invasive centre and 1/3 lived more than 64 kilometres away. 
We included the 18 236 patients who were examined with CAG.  
In all 13 964 (73%) were revascularised.
The cumulative incidence of revascularisation after two 
months was 79% for the third living closest to a centre vs 74%
for those living furthest away.
Distance to invasive centre was associated with less invasive 
revascularisation after the event. 
Even after adjusting for other known risk factors such as  
vessel disease, gender, age , income , education, admission 
year,  previous revasc., comorbidity and medicine use, there 
was a highly significant hazard ratio of 0.80 (95% CI 0. 73-0.85, 
p < 0.0001) of receiving revascularisation for the patients living 
far away in comparison to those living closest. CAG was 
performed at a tertiary centre in 68% among those living 
farthest away vs. 90% among those living closest to a centre.
We investigated if there was a difference in the rate of invasive revascularisation (PCI 
and CABG) after coronary angiography (CAG) following first acute coronary syndrome 
(ACS) depending on distance between place of residence and invasive centre.
Background:
Denmark (population 5.5 million) has a universal 
health insurance coverage system and uniform 
national guidelines for the treatment of ACS.  
Invasive treatment of cardiac patients has been 
centralized to a few highly specialized units.
64  
km
21 
km
Figure 1. Hospitals admitting ACS patients and their locations in Denmark
• We identified, from the National Patient Registry, all patients hospitalized with ACS (both 
STEMI, non-STEMI and UAP) for the first time in 2005-2007. We included those patients 
examined with CAG. Patients were followed for 60 days.
• Information on distance from the patients place of residence to nearest invasive centre 
travelling on normal road was obtained from Statistics Denmark. Patients were grouped in 
tertiles according to distance from home to centre. 
• From the Danish Heart Registry procedures (CAG, PCI and CABG) were identified. 
• Information on comorbidity, medicine use, socioeconomic status and vital status was available 
on each patient.
• Cox proportional-hazard models were used to estimate the difference in the rate of 
revascularisation within 60 days of the admission adjusting for explanatory variables. 
The project is supported by The Danish Heart Foundation.
The research is performed within the DANAMICS* group.
* Danish National Acute Myocardial Infarction Cohort Study
Table 1
1.00
0.94
0.86
1.00
0.990.80
0.75 0.80 0.85 0.90 0.95 1.00 1.05 1.10
Distance < 21 km
21 km < Distance < 64 km
64 km < Distance
Distance < 21 km 
21 km < Distance < 64 km 
64 km < Distance 
Distance to invasive centreModel 1
Adjusted for sex and age
Model 2
Adjusted for vessel disease, sex, age , 
socioeconomic status, admission year,  
previous revasc., comorbidity and medicine use
Figure 2.  Association between distance to an invasive centre and the chance of receiving revascularisation
Distance to invasive centre
Distance < 21 km 21km< Distance <64km 64 km < Distance
ACS-population 8221 8220 8469
Cum inc CAG in %
(95 CI)
76.7 
(75.6-77.7)
74.9
(73.8-75.9)
68.3
(67.2-69.3)
CAG-
population
(%)
6218
(34%)
6130
(34%)
5888
(32%)
Median age
P=0.08 64 65 64
Male gender in %
P=0.01 67.1 67.4 69.4
Cum. Inc. 
revascularisation 
in % (95 CI)
78.6
(77.4-79.9)
76.4
(75.3-77.7)
74.2
(73.0-75.5)
Significant 
stenosis on CAG
P<0.0001
83.9% 77.4% 81.8%
CAG performed in 
an invasive centre
P<0.0001
89.9% 83.6% 67.9%


Lower rate of invasive revascularisation after coronary angiography, following acute coronary syndrome, the longer distance you live from an invasive centres

Lower rate of invasive revascularisation after coronary angiography, following acute coronary syndrome, the longer distance you live from an invasive centres

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