title: Clinical outcomes by geographic region for patients implanted with the zotarolimus-eluting stent.
abstract: BACKGROUND
  Differences between geographic regions in patient characteristics and outcomes, particularly for acute coronary syndromes, have been demonstrated in clinical trials. Clinical outcomes after percutaneous coronary interventions with the Zotarolimus-eluting stent in a real-world population were assessed over time.
  
  
  OBJECTIVE
  The influence of geographic location on clinical outcomes with the Zotarolimus-eluting stent was assessed in 3 regions: Asia Pacific, Europe, and Latin America.
  
  
  METHODS
  A total of 8,314 patients (6,572 Europe, 1,522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2,116 of these (1,613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions.
  
  
  RESULTS
  Patients in Latin America had the highest proportions of risk factors and prior myocardial infarction. Dual antiplatelet therapy usage rapidly declined in Latin America, from 44.9% at 6 months to 22.5% at 1 year and 7.8% at 2 years (Europe: 87.4%, 61.5%, 19.7%; Asia Pacific: 82.4%, 67.0%, 45.7%). There were no significant differences between Latin America and Europe or Asia Pacific for any outcome at either time point. The incidence of Academic Research Consortium definite and probable stent thrombosis was low (<1.2%) among all patients at 1 year and 2 years.
  
  
  CONCLUSIONS
  Clinical outcomes were comparable between patients in Latin America and Europe, and Latin America and Asia Pacific, despite less favorable clinical subsets in Latin America, a higher risk profile, and markedly lower use of dual antiplatelet therapy over time.
authors.affiliation: Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. lotan@hadassah.org.il
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
authors.forename: Ajay
authors.initials: A
authors.lastname: Jain
authors.forename: Fausto
authors.initials: F
authors.lastname: Feres
authors.forename: A
authors.initials: A
authors.lastname: Firszt
authors.forename: A Frutos
authors.initials: AF
authors.lastname: Garcia
authors.forename: Martin T
authors.initials: MT
authors.lastname: Rothman
mesh_terms: D001208:Asia; D049109:Cell Proliferation / Q000187:drug effects; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005060:Europe; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007843:Latin America; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011182:Postoperative Care / Q000706:statistics & numerical data; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; C489443:zotarolimus; D020123:Sirolimus