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European Heart Journal Advance Access originally published online on April 11, 2006
European Heart Journal 2006 27(10):1198-1206; doi:10.1093/eurheartj/ehi854
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial

Padma Kaul1,*, Wei-Ching Chang1, A. Michael Lincoff2, Philip Aylward3, Amadeo Betriu4, Christoph Bode5, Robert M. Califf6, E. Magnus Ohman7, Victor Guetta8, P. Gabriel Steg9, Frans Van de Werf10 and Paul W. Armstrong1

1 University of Alberta, 7, 226 Aberhart Center-I, Edmonton, Alberta, Canada T6G 2J3
2 Cleveland Clinic Foundation, Cleveland, OH, USA
3 Flinders Medical Centre, Adelaide, Australia
4 Institute de Malaties Cardiovasculars, Barcelona, Spain
5 Medizinische Klinik III, Freiburg, Germany
6 Duke Clinical Research Institute, Durham, NC, USA
7 University of North Carolina Medical Center, Durham, NC, USA
8 Ramat-Gan Israel
9 Hospital Bichat, Paris, France
10 Gasthuisberg University Hospital, Leuven, Belgium

Received 25 October 2005; revised 1 March 2006; accepted 9 March 2006; online publish-ahead-of-print 11 April 2006.

* Corresponding author. Tel: + 1 780 407 8680; fax: + 1 780 407 8368. E-mail address: pkaul{at}ualberta.ca

Aims To examine the relationship between revascularization within 7 days and 1-year mortality among ST-elevation myocardial infarction patients enrolled in GUSTO-V trial (n=13 451). To examine the relative contribution of system and patient level factors to the variation in international revascularization rates, and their impact on mortality outcomes.

Methods and results Patients from North America (USA, Canada), Australia, and Europe (UK, France, Germany, Italy, Spain, Poland, Norway, The Netherlands, Belgium, Finland) were included in the study. Revascularization was associated with lower 1-year mortality. Norway, Belgium, Spain, Poland, and Italy also had lower than expected revascularization rates but higher than expected mortality rates. France and USA had almost two times the expected rate of 7-day revascularization, which was associated with modest mortality benefits. Patients' propensity for revascularization based on clinical factors alone was associated with lower 1-year mortality (OR 0.97, 95% CI: 0.96–0.99). Country-level factors had an impact on propensity for revascularization but no impact on 1-year mortality.

Conclusion Our study reveals the potential for some countries with lower than expected 7-day revascularization rates to improve their clinical outcomes. Also highlighted is the possibility for more economically efficient delivery of care in USA and France.

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