Are adverse events following an invasive strategy in patients with non‐ST‐segment elevation acute coronary syndromes more frequent at US sites versus Non‐US sites? analysis from the ACUITY trial
Abstract
Objective: To compare outcomes between US and non‐US (OUS) sites in patients with non ST‐elevation acute coronary syndromes (NSTEACS) and to evaluate potential reasons for differences in outcomes. Background: There are little data comparing outcomes at US versus OUS sites in patients with NSTEACS managed with an invasive strategy. Methods: The ACUITY trial randomized 13,819 patients with NSTEACS in 17 countries to an invasive approach with one of three strategies: (1) heparin plus glycoprotein platelet inhibitors (GPI), (2) bivalirudin plus GPI, or (3) bivalirudin alone. Results: US patients were more often female, were younger, heavier, and had more diabetes, prior myocardial infarction (MI), and prior bypass surgery. US patients were less often treated with percutaneous coronary intervention but had more frequent drug‐eluting stent use. US patients had lower mortality and higher MI rates at 30 days and 1 year and higher composite ischemic outcome at 30 days. After adjusting for differences in baseline variables, US patients had higher rates of MI and composite ischemic outcome at 30 days and higher rates of MI at 1 year {HR [95% confidence interval (CI)] = 1.36 [1.18–1.56], P < 0.0001} with no differences in mortality. There were no differences in treatment effects comparing bivalirudin with the other strategies between US and OUS sites. Conclusions: US versus OUS patients with NSTEACS had higher adjusted rates of MI and ischemia. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care which may impact outcomes. © 2012 Wiley Periodicals, Inc.
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International trials of various pharmacotherapies have sometimes found discordant results in patients enrolled in the United States than seen in overall trial results.
“International trials of various pharmacotherapies have sometimes found discordant results in patients enrolled in the United States than seen in overall trial results.19–32”
From REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States (2020) · cites this paper as [28]
The reasons for discordant US results range from low numbers of patients enrolled in the United States to potential differences in background medical management or in patient risk profiles.
“The reasons range from low numbers of patients enrolled in the United States to potential differences in background medical management or in patient risk profiles.”
From REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States (2020) · cites this paper as [28]
Cites
The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI
Antman, E. M., Cohen, M. C., Bernink, P. J. L. M., McCabe, C. H., Horacek, T., Papuchis, G., Mautner, B., Corbalán, R., Radley, D. R., & Braunwald, E. (2000) · JAMA · doi:10.1001/jama.284.7.835 · Cited by 3,221 · see citing works
Cannon, C. P., Weintraub, W. S., Demopoulos, L. A., Vicari, R. M., Frey, M. J., Lakkis, N. M., Neumann, F., Robertson, D. H., DeLucca, P. T., DiBattiste, P. M., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200106213442501 · Cited by 2,093 · see citing works
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
Bassand, J., Hamm, C. W., Ardissino, D., Boersma, E. H., Budaj, A., Fernández‐Avilés, F., Fox, K. A. A., Hasdai, D., Ohman, E. M., Wallentin, L. C., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm161 · Cited by 1,850 · see citing works
Bivalirudin for Patients with Acute Coronary Syndromes
Stone, G. W., McLaurin, B. T., Cox, D. A., Bertrand, M. E., Lincoff, A. M., Moses, J. W., White, H. D., Pocock, S., Ware, J. H., Feit, F., et al. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa062437 · Cited by 1,461 · see citing works
Self-citationFox, K. A. A., Poole-Wilson, P. A., Henderson, R., Clayton, T. C., Chamberlain, D. A., Shaw, T., Wheatley, D., & Pocock, S. (2002) · The Lancet · doi:10.1016/s0140-6736(02)09894-x · Cited by 898 · see citing works
Routine vs Selective Invasive Strategies in Patients With Acute Coronary Syndromes
Mehta, S. R., Cannon, C. P., Fox, K. A. A., Wallentin, L. C., Boden, W. E., Spacek, R., Widimský, P., McCullough, P. A., Hunt, D. U., D, E. B. M., et al. (2005) · JAMA · doi:10.1001/jama.293.23.2908 · Cited by 819 · see citing works
Rogers, W. J., Frederick, P. D., Stoehr, E., Canto, J. G., Ornato, J. P., Gibson, C. M., Pollack, C. V., Gore, J. M., Chandra‐Strobos, N., Peterson, E. D., et al. (2008) · American Heart Journal · doi:10.1016/j.ahj.2008.07.030 · Cited by 421 · see citing works
Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E., Chavey, W. E., Fesmire, F. M., Hochman, J. S., Levin, T. N., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318212bb8b · Cited by 346 · see citing works
Trends in Incidence, Severity, and Outcome of Hospitalized Myocardial Infarction
Roger, V. L., Weston, S. A., Gerber, Y., Killian, J. M., Dunlay, S. M., Jaffe, A. S., Bell, M. R., Kors, J. A., Yawn, B. P., & Jacobsen, S. J. (2010) · Circulation · doi:10.1161/circulationaha.109.897249 · Cited by 336 · see citing works
Stone, G. W., Bertrand, M. E., Colombo, A., Dangas, G., Farkouh, M. E., Feit, F., Lansky, A. J., Lincoff, A. M., Mehran, R., Moses, J. W., et al. (2004) · American Heart Journal · doi:10.1016/j.ahj.2004.04.036 · Cited by 232 · see citing works
Self-citationFurman, M. I., Dauerman, H. L., Goldberg, R. J., Yarzbeski, J., Lessard, D., & Gore, J. M. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01203-7 · Cited by 216 · see citing works
Periprocedural Myocardial Infarction
Lansky, A. J., & Stone, G. W. (2010) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.110.959080 · Cited by 160 · see citing works
Self-citationHolmes, D. R., Califf, R. M., de Werf, F. V., Berger, P. B., Bates, E., Simoons, M. L., White, H. D., Thompson, T., & Topol, E. J. (1997) · The Lancet · doi:10.1016/s0140-6736(96)03031-0 · Cited by 101 · see citing works
Akkerhuis, K. M. (2000) · European Heart Journal · doi:10.1053/euhj.1999.1743 · Cited by 67 · see citing works
Fox, K. A. A. (2000) · European Heart Journal · doi:10.1053/euhj.1999.1983 · Cited by 45 · see citing works
Variability in the assessment of adverse events in a multicenter clinical trial
Raisch, D. W., Troutman, W. G., Sather, M. R., & Fudala, P. J. (2001) · Clinical Therapeutics · doi:10.1016/s0149-2918(01)80153-3 · Cited by 23 · see citing works
Singh, M., Williams, B. A., Gersh, B. J., McClelland, R. L., Ho, K. K. L., Willerson, J. T., Penny, W. F., Cutlip, D. E., & Holmes, D. R. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.07.066 · Cited by 19 · see citing works
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REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States
Bhatt, D. L., Miller, M., Brinton, E. A., Jacobson, T. A., Steg, P. G., Ketchum, S. B., Doyle, R. T., Juliano, R. A., Jiao, L., Granowitz, C., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.044440 · Cited by 136 · see citing works
Vaduganathan, M., Harrington, R. A., Stone, G. W., Steg, P. G., Gibson, C. M., Hamm, C. W., Price, M. J., Prats, J., Deliargyris, E. N., Mahaffey, K. W., et al. (2016) · Circulation: Cardiovascular Interventions · doi:10.1161/circinterventions.116.003612 · Cited by 12 · see citing works
Self-citation
- Authors
- Tobbia, P., Brodie, B. R., Stuckey, T., McLaurin, B. T., Cox, D. A., Fahy, M., Xu, K., Mehran, R., & Stone, G. W.
- Affiliations
- Cone Health (US)
- AnMed Health (US)
- Lehigh Valley Health Network (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Brodie, Bruce R.
- ORCID
- Venue
- Catheterization and Cardiovascular Interventions
- Publisher
- Wiley
- Published
- 2013-03-09
- Volume
- 82
- Issue
- 4
- Pages
- E365-74
- ISSN
- 1522-1946 (ISSN-L)
- 1522-726X
- OpenAlex
- W1549769145
- Cited by
- 2
- References
- 18
- Citations by year
- 2019: 1 · 2016: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Catheterization and Cardiovascular Interventions (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- non-ST-elevation acute coronary syndrome, invasive strategy, adverse events, ACUITY trial, bivalirudin, glycoprotein IIb/IIIa inhibitors, heparin, percutaneous coronary intervention, drug-eluting stents, myocardial infarction, mortality
- MeSH terms
- Aged, Anticoagulants, Coronary Artery Bypass, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Myocardial Infarction, Platelet Aggregation Inhibitors, Risk Factors, Time Factors, United States, Treatment Outcome, Acute Coronary Syndrome, Healthcare Disparities, Drug-Eluting Stents, Percutaneous Coronary Intervention
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