Editorial Role of a New Cardiac Catheterization Laboratory in Advancing Cardiovascular Care and Outcomes in Post-Myocardial Infarction Patients Papel de un nuevo laboratorio de cateterismo cardiaco en la mejora de la asistencia cardiovascular y sus resultados en pacientes con infarto de miocardio William E. Boden,* Vipul Gupta, and Alpesh Patel Division of Cardiovascular Medicine, Department of Medicine, Schools of Medicine and Public Health, University at Buffalo, Buffalo, New York, USA Cardiovascular disease (CVD) is the leading cause of death in the European Union (EU) and accounts for about 40% of all deaths or approximately 2 million deaths per year. 1 CVD also poses a significant financial burden for EU healthcare systems, which has been estimated to be just under s110 billion (2006). 1 In Spain, CVD represents the number one cause of death, accounting for almost 34% of all mortalities. Within this group, ischemic heart disease is the leading cause of death in men. These sobering statistics clearly emphasize the critical need to better define and enact specific healthcare plans and approaches to mitigate the consequences of acute myocardial infarction (MI), which represents the most severe—yet eminently treatable— expression of CVD through enhanced patient access to specialized tertiary services and life-saving technology. There is an abundance of medical literature to support the important role for the prompt and timely diagnosis and management of patients with acute MI, particularly with the advent of primary percutaneous coronary intervention (PCI) for acute MI and acute coronary syndromes. In this issue of Revista Espan ˜ola de Cardiologı´a, the REGICOR investigators report their single-site clinical experience of out- comes using a longitudinal, comparative analysis before and after the establishment of a cardiac catheterization facility. 2 In this study the REGICOR authors evaluated the impact of opening an on-site diagnostic cardiac catheterization facility on 30-day and 2-year cardiovascular mortality in patients aged 25-74 admitted with acute MI. The authors compared clinical outcomes of MI patients during two temporal periods of observation, one of which (from 1995-1997) was defined as the first, or referent, period, and a later time interval (from 1999-2003) that was defined as the second period, with access to the cardiac catheterization laboratory that opened in 1998. As part of this temporal ‘‘before and after’’ analysis, the authors prospectively evaluated 1,539 consecutive acute MI patients, of which 641 were admitted with acute MI in the first, pre-catheterization laboratory period and 898 consecutive MI patients who were admitted with acute MI in the second, post-catheterization laboratory period. As noted above, the primary outcome measure for this comparative analysis was 30-day and 2-year cardiovascular mortality. A secondary objective was to compare the effect of the post-MI discharge medication regimen on clinical outcomes in these patients. In light of the continued evolution in the definition of acute MI that has occurred over the past decade (most recently, the new American College of Cardiology [ACC]/American Heart Association [AHA]/European Society of Cardiology [ESC] MI Guidelines 3,4 ) and because of increasingly more sensitive and sophisticated bio- chemical assays to detect smaller amounts of myocardial necrosis during the study periods, there is not a standardized or uniform definition of MI in this temporal assessment of MI outcomes by the REGICOR Group investigators, as compared with the current MI definition. Moreover, in-person follow-up was not directly ascertained in this study, inasmuch as a telephonic 2-year follow-up was conducted on patients who survived the first 30 days after index MI event. Nevertheless, the authors found— perhaps not surprisingly—that concomitant with the availability of an on-site catheterization laboratory, the number of coronary catheterization and PCI procedures increased. Additionally, time- to-procedure decreased in the second time period, as would be expected with the advent of an on-site, invasive facility. The principal findings of the current study reveal that at 30 days the rate of death or post-infarction angina was lower in the second period, with the initiation of an on-site cardiac catheterization laboratory, and at 2 years of follow-up the all-cause and cardiovascular death rates were likewise lower in the second period, which in part may also be contributed by the increased use of evidence-based medical therapy for these MI patients at hospital discharge. However, just as cardiac catheterization and catheter-based intervention has evolved dramatically over the past 10-20 years, so too has the robustness and intensity of medical therapy and secondary prevention. With mounting (and compel- ling) scientific evidence derived from multiple randomized trials, it is clear that physicians have a wider therapeutic armamentarium from which to choose clinically in MI patients, including Rev Esp Cardiol. 2011;64(2):87–88 ARTICLE INFO Article history: Available online 28 January 2011 DOI OF RELATED ARTICLE: 10.1016/j.rec.2010.06.011 IN Rev Esp Cardiol. 2011;64:96–104. * Corresponding author: Division of Cardiology, University at Buffalo, 100 High Street, Buffalo, NY 14260, USA. E-mail address: wboden@kaleidahealth.org (W.E. Boden). 1885-5857/$ – see front matter ß 2010 Sociedad Espan ˜ ola de Cardiologı ´a. Published by Elsevier Espan ˜ a, S.L. All rights reserved. doi:10.1016/j.rec.2010.10.012