Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II

Giugliano, Robert P.; Llevadot, Joan; Wilcox, Robert G.; Gurfinkel, Enrique P.; McCabe, Carolyn H.; Charlesworth, Andrew; Thompson, Sharon; Antman, Elliott M.

doi:10.1053/euhj.2001.2583

Cited by 65 publications

(27 citation statements)

References 29 publications

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“…Our analysis also confirmed the low use of invasive revascularization procedures in Eastern Europe identified in previous registries and trials, but failed to correlate this trend with poor outcomes [14][15][16]. Adjustment for differences in revascularization rates actually exacerbated the differences in outcomes found between Eastern Europe and other regions.…”

Section: Discussionsupporting

confidence: 89%

Treatment and outcomes of eastern Europeans with coronary syndromes in OPUS-TIMI 16

Gurjeva¹,

Bukhman

Murphy

et al. 2005

International Journal of Cardiology

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Section: Discussionsupporting

confidence: 89%

Treatment and outcomes of eastern Europeans with coronary syndromes in OPUS-TIMI 16

Gurjeva¹,

Bukhman

Murphy

et al. 2005

International Journal of Cardiology

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“…20 Reasons for the differences between our observations and theirs may reflect a smaller gradient in revascularization across the four geographic regions shown and the differences in analytical approaches employed. Recent data from Stenestrand and Wallentin in patients with both NSTEMI and STEMI from a Swedish registry seem to reaffirm our finding of a mortality benefit in the first year from revascularization following STEMI.…”

Section: Discussionmentioning

confidence: 59%

International differences in in-hospital revascularization and outcomes following acute myocardial infarction A multilevel analysis of patients in ASSENT-2

Gupta

Chang²,

Werf³

et al. 2003

European Heart Journal

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Background Revascularization rates vary substantially between countries in patients with acute ST-elevation myocardial infarction (STEMI). The impact of early revascularization on clinical outcomes in such patients remains uncertain. The ASSENT-2 fibrinolytic trial provides the opportunity to compare revascularization rates following STEMI in patients across 29 countries, and to explore the relationship between revascularization and clinical outcome. Methods Countries participating in ASSENT-2 were grouped into tertiles according to their in-hospital revascularization rates (<15%, 15-39%, >39%). Baseline characteristics, medication and procedure use, and clinical outcomes of the 16 949 patients enrolled were compared. Multiple Cox regressions were used to assess the relationship between the tertiles and 30-day mortality, the primary endpoint of the ASSENT-2 trial. Multilevel logistic regression models were developed to validate and further extend the findings from the single-level analyses. Results Patients in highest tertile countries were younger, heavier, and more often diabetic or hypertensive. They were more likely to have had a previous myocardial infarction or revascularization procedure. Time to treatment and hospital length of stay were shorter in the highest tertile, and beta-blocker use was more frequent. Stroke rates were low and similar across tertiles, with no statistically significant difference in rates of intracranial haemorrhage. Recurrent ischaemia and reinfarction were less common in the highest tertile. Mortality rates at 30 days were lower for countries with the highest revascularization rates (5.1% vs 6.9% vs 6.5% for the lower two tertiles, P<0.001). At 1 year, mortality remained significantly lower in the highest tertile countries (8.4% vs 10.6% vs 9.9%, P=0.001). Following adjustment for baseline patient characteristics, Cox regression analysis confirmed an excess of 30-day and 1-year mortality in the lowest and intermediate tertiles compared to the highest tertile. The multilevel analyses validated these findings, and demonstrated that a country's life expectancy and the hospital volume were inversely related to both 30-day and 1-year mortality.Conclusions The highest rate of in-hospital revascularization following fibrinolytic therapy for acute myocardial infarction in this international study was associated with a reduction in recurrent ischaemia, reinfarction, and improved survival at both 30 days and at 1 year. The optimal rates of revascularization in this setting remain to be determined.

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“…This might have been the reason behind the delayed hospital presentation and lower reperfusion rate. Previous studies suggest that when regional differences are detected they can be linked to higher revascularization rates and not to the baseline patient characteristics [16,17] . Reductions in barriers to timely administration of thrombolytic therapy were previously shown to result in improved survival [18] .…”

Section: Discussionmentioning

confidence: 99%

Regional Variability in Hospital Mortality in Patients Hospitalized with ST-Segment Elevation Myocardial Infarction: Findings from the Gulf Registry of Acute Coronary Events

et al. 2011

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Objectives: To study the short-term mortality from ST-segment elevation myocardial infarction (STEMI) in the Arabian Gulf region of the Middle East, and to examine whether these geographically and culturally related countries had similar or different outcomes. Subjects and Methods: The Gulf Registry of Acute Coronary Events recruited consecutive acute coronary syndrome patients from six Middle Eastern countries over a 5-month period. Results: Of 6,706 patients recruited, 2,626 (39%) had STEMI, and a total of 165 patients died in hospital, with a crude mortality rate of 6.3%. However, mortality rates varied geographically between 10% in Yemen, 9.6% in Oman and 3.3% in the other countries. The unadjusted odds ratio of mortality for Yemen was 3.2 (95% CI: 2.2–4.7), and 3.1 (95% CI: 1.9–4.8) for Oman, compared to other Gulf countries. Even after adjusting for age and gender, the mortality remained significantly higher, almost double, in Oman and Yemen compared to other countries. This could be understood in the light of significant differences in a number of practice pattern variables such as reperfusion therapy, timely presentation and use of evidence-based medications. Conclusion: We found significant variability in STEMI mortality among Gulf Arab countries and identified areas requiring further efforts to reduce excess mortality in the region.

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Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II

Cited by 65 publications

References 29 publications

Treatment and outcomes of eastern Europeans with coronary syndromes in OPUS-TIMI 16

Treatment and outcomes of eastern Europeans with coronary syndromes in OPUS-TIMI 16

International differences in in-hospital revascularization and outcomes following acute myocardial infarction A multilevel analysis of patients in ASSENT-2

Regional Variability in Hospital Mortality in Patients Hospitalized with ST-Segment Elevation Myocardial Infarction: Findings from the Gulf Registry of Acute Coronary Events

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