Results of Expert MeetingsA tale of two countries: Insights from the differences in Canadian/American patterns of care for patients with acute coronary syndromes☆,☆☆
Section snippets
Methods
This review summarizes elements from a selection of multinational randomized cardiovascular clinical trials that have included comparisons between the United States and Canada. One of the first such analyses, published in 1993, was based on data from the Survival and Ventricular Enlargement (SAVE) study,21 which enrolled patients from 1987 to 1990. The analysis in the current article focuses on three more recent ACS trials in which we have been involved: the Global Utilization of Streptokinase
Baseline characteristics
Although some differences in baseline characteristics between countries might be expected, certain trends are apparent across all the trials for which data are available (Table I).Empty Cell Country GUSTO-I (1990-93) GUSTO-IIb ST elevation (1994-95) GUSTO-IIb non-ST elevation (1994-95) GUSTO-III (1995-97) Age (y) Canada 60 (51, 69) 63 (55, 71) 64 (55, 73) 62 (52, 71) US 61 (52, 69) 63 (52, 71) 64 (54, 73)
Discussion
Between the US and Canadian patients who have been enrolled in ACS trials, there are important differences in patient characteristics, use of invasive procedures, and some clinical outcomes, and consistent trends are apparent across several studies over time. Canadian patients tend to be significantly lighter, less likely to be female, and less likely to be diagnosed with hypertension and hypercholesterolemia than their US counterparts. They are also far less likely to have undergone prior
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Reprint requests: J. Conor O’Shea, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail: [email protected]
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Am Heart J 2001;142:14-20.