APOLLO: International Comparison of Outcomes Among Stable Patients Post-AMI

New data has found that the risk of cardiovascular events was high across three years in the U.S., Sweden, England and France, and the predictors for identifying increased risk of cardiovascular or bleeding events in post-myocardial infarction (MI) survivors were similar across these different countries, according to results of the APOLLO trial presented Aug. 31 at ESC Congress 2014.

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Contrasting the atherothrombotic events, death and bleeding risks in one-year post-MI survivors across the four countries, the investigation, led by Eleni Rapsomaniki, MD, PhD, Farr Institute of Health Informatics Research, University College London, UK, analyzed linked electronic health records and registries and administrative data according to common disease definitions based on admission ICD-10 codes and common analysis protocol.

With a study population of 140,887, results showed that compared to Swedish and English patients (mean age -70), French patients were younger (mean age 66) and healthier, and U.S. patients were older (minimum age 65; mean age 79) with more comorbidities and higher adjusted all-cause mortality. Among the various outcome predictors were age (54-100 percent aged ≥65), male gender (51-68 percent), diabetes (21-35 percent), history of having greater than one MI (12-19 percent), stroke (7-10 percent), heart failure (21-45 percent), peripheral arterial disease (1-10 percent), renal disease (3-7 percent), prior hospitalization for bleeding (4-17 percent), atrial fibrillation (14-28 percent), chronic obstructive pulmonary disease (8-28 percent), and cancer (7-12 percent), all of which had similarly positive associations with the outcomes in each country.

The countries' use of percutaneous coronary intervention (42-62 percent) and coronary artery bypass grafting (6-17 percent) in the year post-MI was associated with lower risk across all studies and outcomes. Large differences were not only observed in the three-year cumulative risk for the composite of MI, stroke, or death across the nations, ranging from 17.3 percent (France) to 36.2 percent (U.S.), but in the three-year cumulative risk of hospitalized bleeding, ranging from 2.2 percent (France) to 7.1 percent (U.S.). Following multiple adjustments, risk differences for MI, stroke, or death were minimal, but differences in risk of bleeding remained substantial.

Ultimately the investigators conclude that this new information highlights the importance of comorbidity management in this high-risk population and exemplifies the power and generalizability of prognosis research that makes use of the different countries' clinical records.

Keywords: Stroke, Myocardial Infarction, Comorbidity, Peripheral Arterial Disease, Percutaneous Coronary Intervention, Electronic Health Records, Survivors, Prognosis, Registries, Pulmonary Disease, Chronic Obstructive, International Classification of Diseases, Heart Failure, Coronary Artery Bypass, Diabetes Mellitus

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