TY - JOUR
T1 - Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction
T2 - Insights from the GUSTO-V trial
AU - Kaul, Padma
AU - Chang, Wei Ching
AU - Lincoff, A. Michael
AU - Aylward, Philip
AU - Betriu, Amadeo
AU - Bode, Christoph
AU - Califf, Robert M.
AU - Ohman, E. Magnus
AU - Guetta, Victor
AU - Steg, P. Gabriel
AU - Van De Werf, Frans
AU - Armstrong, Paul W.
N1 - Funding Information:
The GUSTO-V trial was funded by Centocor (Malvern, PA, USA) and Eli Lilly (Indianapolis, IN, USA).
PY - 2006/5
Y1 - 2006/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=33646746787&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehi854
DO - 10.1093/eurheartj/ehi854
M3 - Article
C2 - 16608859
AN - SCOPUS:33646746787
SN - 0195-668X
VL - 27
SP - 1198
EP - 1206
JO - European heart journal
JF - European heart journal
IS - 10
ER -