Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes.
OBJECTIVE
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).


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 2900 US dollars), medium (between 2900 US dollars and 9000 US dollars), and high GNI (more than 9000 US dollars 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%).


CONCLUSIONS
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.
Orlandini
Andrés
A
Estudios Clínicos Latino America (ECLA) Collaborative Group, Jujuy 1415, Rosario 2000, Argentina. aorlandinimd@ecla.org.ar
Díaz
Rafael
R
Wojdyla
Daniel
D
Pieper
Karen
K
Van de Werf
Frans
F
Granger
Christopher B
CB
Harrington
Robert A
RA
Boersma
Eric
E
Califf
Robert M
RM
Armstrong
Paul
P
White
Harvey
H
Simes
John
J
Paolasso
Ernesto
E
D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D014943:Global Health; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics / Q000401:mortality*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies
D005343:Fibrinolytic Agents