Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial.
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.
Kaul
Padma
P
University of Alberta, 7, 226 Aberhart Center-I, Edmonton, Alberta, Canada T6G 2J3. pkaul@ualberta.ca
Chang
Wei-Ching
WC
Lincoff
A Michael
AM
Aylward
Philip
P
Betriu
Amadeo
A
Bode
Christoph
C
Califf
Robert M
RM
Ohman
E Magnus
EM
Guetta
Victor
V
Steg
P Gabriel
PG
Van de Werf
Frans
F
Armstrong
Paul W
PW
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