Publications [#197777] of Daniel B. Mark

Papers Published

1. P Kaul, PW Armstrong, WC Chang, CD Naylor, CB Granger, KL Lee, ED Peterson, RM Califf, EJ Topol, DB Mark, Long-term mortality of patients with acute myocardial infarction in the United States and Canada: comparison of patients enrolled in Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I., Circulation, vol. 110 no. 13 (September, 2004), pp. 1754-60, ISSN 1524-4539 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: In a previous substudy of the GUSTO-I trial, we observed better functional and quality-of-life outcomes among patients in the United States (US patients) compared with patients in Canada. Rates of invasive therapy were significantly higher in the United States and were associated with a small mortality benefit (0.4%, adjusted P=0.02). We sought to determine whether Canadian-US differences in practice patterns in GUSTO-I had an impact on 5-year mortality. RESULTS: Mortality data for 23,105 US and 2898 Canadian patients enrolled in GUSTO-I were obtained from national mortality databases. Median follow-up was 5.46 years in the US and 5.33 years in the Canadian cohort. Five-year mortality rate was 19.6% among US and 21.4% among Canadian patients (P=0.02). After baseline adjustment, enrollment in Canada was associated with a higher hazard of death (1.17; 95% confidence interval, 1.07 to 1.28, P=0.001). Revascularization rates during the index hospitalization in the United States were almost 3 times those in Canada: 30.5% versus 11.4% for angioplasty and 13.1% versus 4.0% for bypass surgery (P<0.01 for both). After accounting for revascularization status as a time-dependent covariate, country was no longer a significant predictor of long-term mortality. These results were confirmed in a propensity-matched analysis. CONCLUSIONS: Our results suggest, for the first time, that the more conservative pattern of care with regard to early revascularization in Canada for ST-segment elevation acute myocardial infarction may have a detrimental effect on long-term survival. Our results have important policy implications for cardiac care in countries and healthcare systems wherein use of invasive procedures is similarly conservative.

   Keywords:
   Aged • Angioplasty • Anticoagulants • Canada • Case Management • Cohort Studies • Comorbidity • Coronary Artery Bypass • Drug Therapy, Combination • Female • Fibrinolytic Agents • Follow-Up Studies • Heparin • Humans • Injections, Intravenous • Injections, Subcutaneous • Male • Middle Aged • Myocardial Infarction • Myocardial Revascularization • Physician's Practice Patterns • Proportional Hazards Models • Streptokinase • Survival Analysis • Thrombolytic Therapy • Tissue Plasminogen Activator • Treatment Outcome • United States • administration & dosage • drug therapy • epidemiology • methods • mortality* • surgery • therapeutic use • therapy • utilization