Skip to main content
Journal cover image

Temporal evolution in the management of acute ST elevation myocardial infarction: the seven-year GUSTO experience from canada and the united states. The North American GUSTO-I and GUSTO-III investigators.

Publication ,  Journal Article
Chang, WC; Fu, Y; Ohman, EM; Gupta, M; Morris, A; Roth, SN; Granger, CB; Califf, RM; Topol, EJ; Mark, DB; Armstrong, PW
Published in: Can J Cardiol
October 2000

BACKGROUND: Temporal changes in baseline characteristics, treatment and clinical outcomes of patients presenting with acute ST elevation myocardial infarction in Canada and the United States have not been examined comprehensively over time. OBJECTIVES: To evaluate baseline characteristics, process of care and clinical outcomes. Also, to explore whether earlier process-of-care differences between Canada and the United States had changed and, if so, whether they influenced clinical outcomes. PATIENTS AND METHODS: A total of 13, 888 American and 3011 Canadian patients enrolled in 184 American and 38 Canadian hospitals that participated in both the Global Utilization of Streptokinase and Tissue Plasminogen Activator (alteplase) for Occluded Coronary Arteries (GUSTO-I) trial (1990 to 1993) and the Global Utilization of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial (1995 to 1997) were studied. Logistic regression was used to identify significant prognostic factors, to assess illness severity at hospital presentation and to classify trends between Canada and the United States. RESULTS: In both countries, illness severity on admission increased, door-to-needle time for thrombolysis was reduced, intensive care unit stay was shortened and hospital stay decreased from GUSTO-I to GUSTO-III. Whereas the administration of oral nitrates, calcium blockers and beta-blockers at discharge converged over time between countries, the disparity in the use of angiography and revascularization widened; the rise in American revascularization rate was most evident in patients without in-hospital ischemia. The 30-day and one-year mortality rates were comparable and declined nonsignificantly in both countries. CONCLUSIONS: Despite increased illness severity and varying medication and procedure rates, there was no increase over time in 30-day or one-year mortality; this remained comparable between countries throughout the seven-year observation period.

Duke Scholars

Published In

Can J Cardiol

ISSN

0828-282X

Publication Date

October 2000

Volume

16

Issue

10

Start / End Page

1231 / 1239

Location

England

Related Subject Headings

  • United States
  • Thrombolytic Therapy
  • Survival Analysis
  • Randomized Controlled Trials as Topic
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chang, W. C., Fu, Y., Ohman, E. M., Gupta, M., Morris, A., Roth, S. N., … Armstrong, P. W. (2000). Temporal evolution in the management of acute ST elevation myocardial infarction: the seven-year GUSTO experience from canada and the united states. The North American GUSTO-I and GUSTO-III investigators. Can J Cardiol, 16(10), 1231–1239.
Chang, W. C., Y. Fu, E. M. Ohman, M. Gupta, A. Morris, S. N. Roth, C. B. Granger, et al. “Temporal evolution in the management of acute ST elevation myocardial infarction: the seven-year GUSTO experience from canada and the united states. The North American GUSTO-I and GUSTO-III investigators.Can J Cardiol 16, no. 10 (October 2000): 1231–39.
Chang WC, Fu Y, Ohman EM, Gupta M, Morris A, Roth SN, Granger CB, Califf RM, Topol EJ, Mark DB, Armstrong PW. Temporal evolution in the management of acute ST elevation myocardial infarction: the seven-year GUSTO experience from canada and the united states. The North American GUSTO-I and GUSTO-III investigators. Can J Cardiol. 2000 Oct;16(10):1231–1239.
Journal cover image

Published In

Can J Cardiol

ISSN

0828-282X

Publication Date

October 2000

Volume

16

Issue

10

Start / End Page

1231 / 1239

Location

England

Related Subject Headings

  • United States
  • Thrombolytic Therapy
  • Survival Analysis
  • Randomized Controlled Trials as Topic
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male