International comparison of mortality rates in patients with non-ST elevation acute coronary events
- 1Coronary Care Unit, Favaloro Foundation, Buenos Aires, Argentina
- 2Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Correspondence to:
Gerardo E Bozovich, MD, Department of Epidemiology, CB # 7435, McGavran-Greenberg Hall, UNC-CH, Chapel Hill, NC 27599-7435, USA;
agbozovich{at}yahoo.com
- Accepted 7 April 2003
- ESSENCE, efficacy and safety of subcutaneous enoxaparin in unstable angina and non-Q wave myocardial infarction
- GRACE, global registry of acute coronary events
- OASIS, organisation to assess strategies for ischaemic syndromes
- PURSUIT, platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using Integrilin
- TIMI, thrombolysis in myocardial infarction
Recently, authors of several studies on acute coronary syndromes have reported that study participants from eastern Europe and South America had poorer outcomes compared to their North American and western European counterparts.1–3 Taking into consideration that all of these studies have in common a very small proportion of participants from regions outside the USA, Canada, or western Europe, this inference may have been based on insufficient data. We sought to compare the inter-regional mortality in the only study that included a comparable proportion of patients from different continents.
METHODS
The TIMI (thrombolysis in myocardial infarction) 11B trial recruited 3910 patients in 200 centres in North and South America and Europe over a period of 19 months (Canada, USA, UK, Spain, France, Germany, The Netherlands, Argentina, Chile, and Uruguay). The design and overall results of the trial have been published.4 Patients were allocated in a double blind manner to either intravenous unfractionated heparin or enoxaparin for at least three days, followed by partial dose of enoxaparin or placebo up to day 43 after inclusion. The present analysis was conducted in a “post hoc” manner to analyse all cause mortality. A central committee adjudicated events. Mortality rates were …
