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Titolo:
Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis - Results from InTIME-II
Autore:
Giugliano, RP; Llevadot, J; Wilcox, RG; Gurfinkel, EP; McCabe, CH; Charlesworth, A; Thompson, SL; Antman, EM; Braunwald, E;
Indirizzi:
Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp, Boston, MA 02115 USA Brigham & Womens Hosp Boston MA USA 02115 Study Grp, Boston, MA 02115 USA Harvard Univ, Sch Med, Boston, MA USA Harvard Univ Boston MA USAHarvard Univ, Sch Med, Boston, MA USA Queens Med Ctr, Div Cardiovasc Med, Nottingham NG7 2UH, England Queens MedCtr Nottingham England NG7 2UH d, Nottingham NG7 2UH, England Fdn Favaloro, Buenos Aires, DF, Argentina Fdn Favaloro Buenos Aires DF Argentina loro, Buenos Aires, DF, Argentina Nottingham Clin Res Grp, Nottingham, England Nottingham Clin Res Grp Nottingham England Res Grp, Nottingham, England
Titolo Testata:
EUROPEAN HEART JOURNAL
fascicolo: 18, volume: 22, anno: 2001,
pagine: 1702 - 1715
SICI:
0195-668X(200109)22:18<1702:GVIPAH>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE CORONARY SYNDROMES; PRACTICE GUIDELINES COMMITTEE; ASSOCIATION TASK-FORCE; UNITED-STATES; CARDIAC PROCEDURES; UNSTABLE ANGINA; INTERREGIONAL DIFFERENCES; ACC/AHA GUIDELINES; BETA-BLOCKADE; TRIAL;
Keywords:
myocardial infarction; fibrinolysis; geographic variation; management; outcomes;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Giugliano, RP TIMI Study Off, 333 Longwood Ave,Suite 402, Boston, MA 02115USA TIMI Study Off 333 Longwood Ave,Suite 402 Boston MA USA 02115
Citazione:
R.P. Giugliano et al., "Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis - Results from InTIME-II", EUR HEART J, 22(18), 2001, pp. 1702-1715

Abstract

Aims We examined the geographic variations in InTIME-II, a randomized double-blind trial comparing alteplase with lanoteplase for myocardial infarction. Methods and Results We compared baseline characteristics management, and outcomes in four re.-ions (Western Europe, Eastern Europe, North America, and Latin America) and in countries with historically different management approaches (Germany vs the U.K., the U.S. vs Canada). Thirty-day mortality inWestern Europe, Eastern Europe, North America and Latin America was 6.7%, 7.3%, 5.7%, 10.1%, P<0.0001. Adjusted mortality for Europe was intermediatebetween North America and Latin America (odds ratios (OR) [95% confidence intervals (CI)] compared to Western Europe: North America 0.84 [0.67-1.0], Eastern Europe 1.2 [1.0-1.4], and Latin America 1.8 [1.3-2.7]). Revascularization rates varied 10-fold but did not explain regional mortality differences. Germany and the U.K. had similar adjusted 1-year mortality (OR for theU.K. 1.16 [0.92-1.5]), although invasive procedures were four- to 10-fold more common in Germany. Similarly the U.S. and Canada had equal adjusted 1-year mortality (OR for Canada 0.85 [0.61-1.17]) despite three-fold higher use of invasive procedures in the U.S. Conclusions Significant geographic variations in practice and adjusted mortality following fibrinolysis persist despite recent guidelines. These findings have important implications in the design and interpretation of international studies, identify under- and over-utilized therapies, and support further study of treatments with marked worldwide variations.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/04/20 alle ore 19:39:41