European Heart Journal Advance Access originally published online on January 12, 2006
European Heart Journal 2006 27(5):527-533; doi:10.1093/eurheartj/ehi701
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Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes
1Estudios Clínicos Latino America (ECLA) Collaborative Group, Jujuy 1415, Rosario 2000, Argentina
2Duke University Medical Center, Durham, NC, USA
3Gasthuisberg University Hospital, Leuven, Belgium
4Erasmus MC, Rotterdam, The Netherlands
5University of Alberta, Edmonton, Alberta, Canada
6Green Lane Hospital, Auckland, New Zealand
7NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
Received 7 February 2005; revised 22 November 2005; accepted 1 December 2005; online publish-ahead-of-print 12 January 2006.
* Corresponding author. Tel: +54 341 4493045; fax: +54 341 4242071. E-mail address: aorlandinimd{at}ecla.org.ar
This paper was guest edited by Prof. Gianni Tognoni, Instituto Mario Negri, Department of Cardiology, Milano, Italy
Aims To evaluate whether there is an association between 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI) included in clinical trials and country gross national income (GNI).
Methods and results A retrospective analysis of the databases of five randomized trials including 50 310 patients with STEMI (COBALT 7169, GIK-2 2931, HERO-2 17 089, ASSENT-2 17 005, and ASSENT-3 6116 patients) from 53 countries was performed. Countries were divided into three groups according to their GNI based on the World Bank data: low (less than US$ 2900), medium (between US$ 2900 and 9000), and high GNI (more than US$ 9000 per capita). Baseline characteristics, in-hospital management variables, and 30-day outcomes were evaluated. A previously defined logistic regression model was used to adjust for differences in baseline characteristics and to predict mortality. The observed mortality was higher than the predicted mortality in the low (12.1 vs. 11.8%) and in the medium income groups (9.4 vs. 7.9%), whereas it was lower in the high income group (4.9 vs. 5.6%).
Conclusion An inverse relationship between mortality and GNI was observed in STEMI clinical trials. Most of the variability in mortality can be explained by differences in baseline characteristics; however, after adjustment, lower income countries have higher mortality than the expected.
Key Words: Regional differences • Outcomes • ST-elevation myocardial infarction • Clinical trials • Gross national income
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