Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: Insights from the GUSTO-V trial

Padma Kaul, Wei Ching Chang, A. Michael Lincoff, Philip Aylward, Amadeo Betriu, Christoph Bode, Robert M. Califf, E. Magnus Ohman, Victor Guetta, P. Gabriel Steg, Frans Van De Werf, Paul W. Armstrong

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Aims: To examine the relationship between revascularization within 7 days and 1-year mortality among ST-elevation myocardial infarction patients enrolled in GUSTO-V trial (n = 13 451). To examine the relative contribution of system and patient level factors to the variation in international revascularization rates, and their impact on mortality outcomes. Methods and results: Patients from North America (USA, Canada), Australia, and Europe (UK, France, Germany, Italy, Spain, Poland, Norway, The Netherlands, Belgium, Finland) were included in the study. Revascularization was associated with lower 1-year mortality. Norway, Belgium, Spain, Poland, and Italy also had lower than expected revascularization rates but higher than expected mortality rates. France and USA had almost two times the expected rate of 7-day revascularization, which was associated with modest mortality benefits. Patients' propensity for revascularization based on clinical factors alone was associated with lower 1-year mortality (OR 0.97, 95% CI: 0.96-0.99). Country-level factors had an impact on propensity for revascularization but no impact on 1-year mortality. Conclusion: Our study reveals the potential for some countries with lower than expected 7-day revascularization rates to improve their clinical outcomes. Also highlighted is the possibility for more economically efficient delivery of care in USA and France.

Original languageEnglish
Pages (from-to)1198-1206
Number of pages9
JournalEuropean heart journal
Issue number10
Publication statusPublished - May 2006

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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