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Higher rates of coronary angiography and revascularization following myocardial infarction may be associated with greater survival in the United States than in Canada. The CARS Investigators (Coumadin/Aspirin Reinfarction Study).

https://arctichealth.org/en/permalink/ahliterature200552
Source
Can J Cardiol. 1999 Oct;15(10):1095-102
Publication Type
Article
Date
Oct-1999
Author
A. Langer
M. Fisher
R M Califf
S. Goodman
C M O'Connor
R A Harrington
V. Fuster
Author Affiliation
St Michael's Hospital, Toronto, Canada.
Source
Can J Cardiol. 1999 Oct;15(10):1095-102
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary
Anticoagulants - therapeutic use
Aspirin - pharmacology - therapeutic use
Canada - epidemiology
Coronary Angiography
Drug Therapy, Combination
Humans
Myocardial Infarction - drug therapy - mortality - surgery
Myocardial Revascularization
Survival Rate
United States - epidemiology
Warfarin - pharmacology - therapeutic use
Abstract
Significant differences are known to exist between the United States and Canada with respect to coronary catheterization and intervention. In a post hoc analysis, it was hypothesized that these differences may have the greatest impact on outcome in patients at risk for recurrent events such as those following myocardial infarction (MI).
The hypothesis was tested in a nonrandomized comparison of the catheterization and revascularization patterns for patients following acute MI in 7029 patients in the United States and 1774 patients in Canada who participated in the Coumadin/Aspirin Reinfarction Study (CARS). CARS tested the effectiveness of low dose warfarin in combination with acetylsalicylic acid (ASA) versus ASA alone in reducing cardiovascular morbidity and mortality.
Before study enrollment (median day 7 to 8), 84.5% of the American patients underwent coronary angiography compared with only 7.7% in Canada (P
PubMed ID
10523476 View in PubMed
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Improved outlook for patients with acute myocardial infarction: an interim progress report.

https://arctichealth.org/en/permalink/ahliterature54321
Source
Eur Heart J. 1998 Oct;19(10):1416-8
Publication Type
Article
Date
Oct-1998

Relation between baseline risk and treatment decisions in non-ST elevation acute coronary syndromes: an examination of international practice patterns.

https://arctichealth.org/en/permalink/ahliterature174305
Source
Heart. 2005 Jul;91(7):876-81
Publication Type
Article
Date
Jul-2005
Author
P. Kaul
L K Newby
Y. Fu
D B Mark
S G Goodman
G S Wagner
R A Harrington
C B Granger
F. Van de Werf
E M Ohman
P W Armstrong
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada. pkaul@ualberta.ca
Source
Heart. 2005 Jul;91(7):876-81
Date
Jul-2005
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Australasia
Canada
Coronary Angiography - methods
Coronary Artery Bypass - methods
Coronary Disease - mortality - physiopathology - therapy
Decision Making
Electrocardiography - methods
Europe
Female
Humans
Male
Middle Aged
Myocardial Reperfusion - methods
Physician's Practice Patterns - trends
Prospective Studies
Risk factors
Survival Analysis
Syndrome
United States
Abstract
To examine the interaction between ST segment depression on the baseline ECG and subsequent in-hospital revascularisation on six month mortality among patients with non-ST elevation acute coronary syndromes. To examine whether ST segment depression influenced clinical decision making and whether there was international variation in the use of cardiac procedures across ST segment depression categories.
11 453 patients enrolled in GUSTO-IIB (global use of strategies to open occluded coronary arteries), PARAGON (platelet IIb/IIIa antagonism for the reduction of acute coronary syndrome events in a global organisation network) -A, and PARAGON-B were studied. Patients were categorised as having no ST segment depression, 1 mm ST segment depression in two contiguous leads, and ST segment depression > or = 2 mm in two contiguous leads. International practice across four geographic regions was examined: USA, Canada, Europe, and Australia/New Zealand.
Revascularisation appeared to have no impact on survival among patients with no ST segment depression; however, revascularisation was associated with a significant survival benefit among patients with ST segment depression > or = 1 mm. There was an inverse relation between the extent of ST segment depression and the use of angiography as well as angioplasty (p or = 2 mm were more likely to undergo bypass surgery. The only significant trend of increasing use of revascularisation procedures with increasing ST segment depression was observed in the USA.
International practice patterns in procedure use appear to be insensitive to the extent of ST segment depression. Major opportunities for more efficient delivery of care exist in all regions.
Notes
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Comment In: Heart. 2005 Jul;91(7):851-315958340
PubMed ID
15958353 View in PubMed
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