BACKGROUND: Registries and clinical trials have offered limited evidence on the translation of acute coronary syndrome trial findings into local practices in Eastern Europe. We examined differences in acute coronary syndrome treatment and outcomes between Eastern Europe and other regions in OPUS TIMI-16, a multinational trial of oral glycoprotein IIb/IIIa inhibition for ST-segment and non-ST-segment elevation acute coronary syndromes conducted between 1997 and 1999. METHODS AND RESULTS: We compared variation in baseline characteristics, adjunctive treatment, and outcomes of patients in Eastern Europe and other regions of the world. We found that during this period, Eastern European sites made significantly more use of medications for coronary prevention before and after hospitalization. These sites, however, also made less use of adjunctive medications during their hospitalization. Fewer Eastern European patients received lipid-lowering medication both prior to admission and following discharge. Eastern European patients also underwent fewer percutaneous coronary interventions. Patients in Eastern Europe had worse outcomes at 30 days and at 10 months. CONCLUSION: This study revealed disparities in the use of medical treatments and percutaneous coronary interventions between Eastern European sites and trial sites in other countries. These findings indicate the need for studies to address the sources of treatment and outcome variation. The underuse of effective treatment modalities in all regions calls for strategies to improve access to cardiovascular therapies.
BACKGROUND: Registries and clinical trials have offered limited evidence on the translation of acute coronary syndrome trial findings into local practices in Eastern Europe. We examined differences in acute coronary syndrome treatment and outcomes between Eastern Europe and other regions in OPUS TIMI-16, a multinational trial of oral glycoprotein IIb/IIIa inhibition for ST-segment and non-ST-segment elevation acute coronary syndromes conducted between 1997 and 1999. METHODS AND RESULTS: We compared variation in baseline characteristics, adjunctive treatment, and outcomes of patients in Eastern Europe and other regions of the world. We found that during this period, Eastern European sites made significantly more use of medications for coronary prevention before and after hospitalization. These sites, however, also made less use of adjunctive medications during their hospitalization. Fewer Eastern European patients received lipid-lowering medication both prior to admission and following discharge. Eastern European patients also underwent fewer percutaneous coronary interventions. Patients in Eastern Europe had worse outcomes at 30 days and at 10 months. CONCLUSION: This study revealed disparities in the use of medical treatments and percutaneous coronary interventions between Eastern European sites and trial sites in other countries. These findings indicate the need for studies to address the sources of treatment and outcome variation. The underuse of effective treatment modalities in all regions calls for strategies to improve access to cardiovascular therapies.
Authors: Karen E Lutfey; Carol L Link; Lisa D Marceau; Richard W Grant; Ann Adams; Sara Arber; Johannes Siegrist; Markus Bönte; Olaf von dem Knesebeck; John B McKinlay Journal: Med Decis Making Date: 2009-05-21 Impact factor: 2.583