International Variation in Invasive Procedures and Outcomes in Acute Myocardial Infarction - CORE

Description:

Utilization of invasive procedures and clinical outcomes in acute MI.

Hypothesis:

(1) to assess, among acute MI patients eligible for thrombolysis, international variations in frequencies of invasive procedures (angiography, PTCA, CABG) and outcomes (mortality and composite outcome) and (2) to correlate the rates of invasive procedures with patient risk profiles and outcomes.

Study Design

Study Design:

Primary Endpoints:

Risk score

Secondary Endpoints:

35-day mortality

Principal Findings:

The investigators found substantial variation in the use of cardiac invasive procedures among the patients eligible for thrombolysis. The mean risk score and the proportions of high risk patients also varied significantly among countries.

No correlation was found between risk score, proportion of high risk patients, and the frequency of angioplasty performed, and no correlation was noted between the frequency of angioplasty and deaths at 35 days. However, a positive correlation between the rate of angioplasty and composite outcome at 35 days was revealed, suggesting no beneficial overall effect of invasive procedures most likely without specific indications.

Interpretation:

The investigators stated that the conclusions concerning the relationship between the frequency of angioplasty and outcomes should be treated with caution. Further prospective studies are needed to explain the differences between the United States and United Kingdom patterns of practice and outcomes and their economic and ethical aspects.

References:

1. Eur Heart J 1998;19(Abstr Suppl):254.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Risk, Great Britain, Myocardial Infarction, Angioplasty, United States


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