Variations in practice and outcomes in patients undergoing primary percutaneous coronary intervention in the United States and Canada: insights from the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial.
Journal Article
Background
Information on practice patterns and outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventions (PCIs) in Canada vs United States is limited.Methods
We evaluated differences in clinical and angiographic features, practice patterns, and outcomes between Canada and United States in 2,086 patients with ST-elevation myocardial infarction undergoing primary PCI in the APEX AMI trial.Results
Of 2,086 patients, 335 (19%) were enrolled in Canada. Compared with US patients, Canadians were older with lower body mass index and creatinine clearance and less likely to have history of hypertension, smoking, or prior revascularization. Baseline infarct artery patency was higher, and the use of intra-aortic balloon pump and drug-eluting stents was lower in Canadian patients. Median door-to-PCI time was significantly shorter among Canadian patients (0.9 hours [interquartile range 0.6-1.3] vs 1.2 hours [interquartile range 0.8-1.7]). Clinical outcomes at 90 days were lower among Canadian patients, including shock (2.7% vs 4.2%), heart failure (3.6% vs 5.6%), bleeding (3.6% vs 9.6%), and atrial (3.6% vs 7.4%) and ventricular (3.0% vs 6.4%) arrhythmias. However, 90-day mortality (2.7% vs 4.8%, adjusted hazard ratio 0.62, 95% CI 0.47-1.28) and composite of death, shock, or heart failure (6.8% vs 11.5%, adjusted hazard ratio 0.77, 95% CI 0.47-1.27) were similar in the 2 cohorts.Conclusions
Compared with US patients, Canadian patients had shorter door-to-PCI time but similar 90-day outcomes. These data suggest an opportunity for US sites to examine and learn from the Canadian systems of processes of care and implement changes so as to improve the timeliness of primary PCI.Full Text
Duke Authors
- Armstrong, Paul Wayne
- Granger, Christopher Bull
- Lopes, Renato Delascio
- Mehta, Rajendra H.
- Patel, Manesh Raman
Cited Authors
- Mehta, RH; Kaul, P; Lopes, RD; Patel, MR; Zheng, Y; Pieper, KS; Welsh, RC; Armstrong, PW; Granger, CB
Published Date
- May 2012
Published In
Volume / Issue
- 163 / 5
Start / End Page
- 797 - 803
PubMed ID
- 22607857
Pubmed Central ID
- 22607857
Electronic International Standard Serial Number (EISSN)
- 1097-6744
International Standard Serial Number (ISSN)
- 0002-8703
Digital Object Identifier (DOI)
- 10.1016/j.ahj.2012.03.001
Language
- eng