European Heart Journal Advance Access published online on April 11, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi854
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1 University of Alberta, 7226 Aberhart Center-I, Edmonton, Alberta, Canada T6G 2J3
* To whom correspondence should be addressed. 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.
Received October 25, 2005
Revised March 1, 2006
Accepted March 9, 2006
Clinical research
Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial
Padma Kaul 1 *,
Wei-Ching Chang 1,
Michael A. Lincoff 2,
Philip Aylward 3,
Amadeo Betriu 4,
Christoph Bode 5,
Robert M. Califf 6,
Magnus E. Ohman 7,
Victor Guetta 8,
Gabriel P. Steg 9,
Frans Van de Werf 10,
and
Paul W. Armstrong 1
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
Padma Kaul, E-mail: pkaul{at}ualberta.ca
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