A comparison of clinical outcomes between Canadian and American patients after nonurgent coronary stenting.
BACKGROUND
Practice patterns for percutaneous coronary interventions (PCIs) may differ between Canada and the United States. Few data are available comparing PCI outcomes between the two countries in the era of coronary stenting and adjunctive glycoprotein IIb/IIIa inhibition.


METHODS
In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, 2064 patients were randomly assigned to receive eptifibatide or placebo during nonurgent PCI. The 30-day and one-year rates of death, myocardial infarction (MI) and target vessel revascularization (TVR) were compared between Canadian and American patients enrolled in the ESPRIT trial.


RESULTS
There were 1531 American patients and 533 Canadian patients enrolled. Americans were older and heavier, and had a higher incidence of cardiac risk factors than Canadians (P<0.05 for all variables). Canadian patients had a lower incidence of death, MI and TVR at 30 days (6.2% versus 10.4%, P=0.004) and at one year (14.8% versus 21.5%, P=0.0006). After adjusting for known baseline differences, enrollment in Canada remained a significant predictor of reduced ischemic complications at 30 days (OR=0.53, c2=9.0, P=0.003). Similar results were observed at one year. Eptifibatide was superior to placebo in both groups of patients.


CONCLUSIONS
This analysis is among the first to show Canadian patients to have fewer adverse events than American patients after nonurgent PCI. This effect was independent of known baseline differences between the patients in each country. The relative treatment effect of eptifibatide in Canadian patients paralleled that observed in the main ESPRIT trial and in American patients.
Madan
Mina
M
Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. mina.madan@sw.ca
Labinaz
Marino
M
Cohen
Eric A
EA
Buller
Christopher E
CE
Cantor
Warren J
WJ
Seidelin
Peter
P
Ducas
John
J
Carere
Ronald G
RG
Natarajan
Madhu K
MK
Pieper
Karen S
KS
Hafley
Gail E
GE
O'Shea
J Conor
JC
Kitt
Michael M
MM
Califf
Robert M
RM
Tcheng
James E
JE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002170:Canada; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000008:administration & dosage; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
D019039:Platelet Glycoprotein GPIIb-IIIa Complex