Long-term mortality of patients with acute myocardial infarction in the United States and Canada - Comparison of patients enrolled in global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO)-I
Long-term mortality of patients with acute myocardial infarction in the United States and Canada - Comparison of patients enrolled in global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO)-I
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DOI：
10.1161/01.cir.0000142671.06167.91
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发表时间：
2004-09-28
期刊：
影响因子：
37.8
通讯作者：
Mark, DB
中科院分区：
文献类型：
--
作者：
Kaul, P;Armstrong, PW;Mark, DB
背景-在GUSTO-I试验的先前子研究中，我们观察到与加拿大患者相比，美国患者的功能和生活质量结局更好。在美国，侵入性治疗的发生率显著较高，并且与较小的死亡率获益相关（0.4%，校正后P=0.02）。我们试图确定是否在GUSTO-I的实践模式中，美国的差异有5年mortality.Methods和Results-Mortality数据的影响，23 105美国和2898加拿大患者参加GUSTO-I从国家死亡率数据库中获得。美国队列的中位随访时间为5.46年，加拿大队列为5.33年。美国患者的5年死亡率为19.6%，加拿大患者为21.4%（P=0.02）。基线调整后，在加拿大入学与更高的死亡风险相关（1.17; 95%置信区间，1.07至1.28，P=0.001）。美国首次住院期间的血运重建率几乎是加拿大的3倍：血管成形术为30.5%对11.4%，旁路手术为13.1%对4.0%（P
Background-In a previous substudy of the GUSTO-I trial, we observed better functional and quality-of-life outcomes among patients in the United States (US patients) compared with patients in Canada. Rates of invasive therapy were significantly higher in the United States and were associated with a small mortality benefit (0.4%, adjusted P=0.02). We sought to determine whether Canadian-US differences in practice patterns in GUSTO-I had an impact on 5-year mortality.Methods and Results-Mortality data for 23 105 US and 2898 Canadian patients enrolled in GUSTO-I were obtained from national mortality databases. Median follow-up was 5.46 years in the US and 5.33 years in the Canadian cohort. Five-year mortality rate was 19.6% among US and 21.4% among Canadian patients (P=0.02). After baseline adjustment, enrollment in Canada was associated with a higher hazard of death (1.17; 95% confidence interval, 1.07 to 1.28, P=0.001). Revascularization rates during the index hospitalization in the United States were almost 3 times those in Canada: 30.5% versus 11.4% for angioplasty and 13.1% versus 4.0% for bypass surgery (P