AIMS: 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. METHODS AND 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. CONCLUSION: 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.
RCT Entities:
AIMS: To examine the relationship between revascularization within 7 days and 1-year mortality among ST-elevation myocardial infarctionpatients 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. METHODS AND 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. CONCLUSION: 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: Simon A Mahler; Chadwick D Miller; Harold I Litt; Constantine A Gatsonis; Bradley S Snyder; Judd E Hollander Journal: Acad Emerg Med Date: 2015-03-24 Impact factor: 3.451
Authors: Jason Stopyra; Anna Catherine Snavely; Brian Hiestand; Brian J Wells; Kristin Macfarlane Lenoir; David Herrington; Nella Hendley; Nicklaus P Ashburn; Chadwick D Miller; Simon A Mahler Journal: Heart Date: 2020-04-08 Impact factor: 5.994
Authors: Jason P Stopyra; Chadwick D Miller; Brian C Hiestand; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; Robert F Riley; Gregory B Russell; James W Hoekstra; Simon A Mahler Journal: Crit Pathw Cardiol Date: 2015-12