title: Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Alberta, 7, 226 Aberhart Center-I, Edmonton, Alberta, Canada T6G 2J3. pkaul@ualberta.ca
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Wei-Ching
authors.initials: WC
authors.lastname: Chang
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.forename: Philip
authors.initials: P
authors.lastname: Aylward
authors.forename: Amadeo
authors.initials: A
authors.lastname: Betriu
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome