Aggressive treatment of US patients with myocardial infarction did not improve mortality (28% vs 27%) or reinfarction (13% vs 8%) compared to conservative treatment in Canadian patients (P>0.05).
Cohort (n=518)
Yes
Does an aggressive treatment practice pattern improve clinical outcomes and functional status compared to a conservative treatment practice pattern in patients with acute myocardial infarction?
An aggressive, invasive treatment approach for myocardial infarction in the US did not improve mortality or reinfarction rates compared to a more conservative approach in Canada, though it was associated with better functional status.
Absolute Event Rate: 28% vs 27%
p-value: p=>0.05
OBJECTIVE: To compare practice patterns and clinical outcomes for a costly yet common condition, acute myocardial infarction. DESIGN: Retrospective cohort study in two university hospitals (Stanford Calif University and McGill University, Montreal, Quebec) and a patient survey. PATIENTS: All consecutive patients (n = 518) treated for acute myocardial infarction in the coronary care unit of those two hospitals over 2 years. MEASURES: Rates of diagnostic and therapeutic procedures, mortality, reinfarction, and level of functional status (by chart review and patient survey). RESULTS: Demographic and clinical characteristics were similar for the two groups. Noninvasive tests were more common at McGill (exercise tests, 56% vs 20%; tests of left ventricular function, 86% vs 59%; P .05 for both). In contrast, the angina rate was slightly lower at Stanford (33% vs 40%; P = .15), and the functional status of Stanford patients was better than that of McGill patients (mean Duke Activity Status Index score, 28.8 and 22.9, respectively; P = .006). This functional status difference persisted after adjustment for differences in clinical factors, including coronary revascularization. CONCLUSION: The aggressive treatment of the American patients with myocardial infarction did not improve reinfarction and mortality rates compared with the conservative treatment of the Canadian patients. The superior functional status of the American patients merits further investigation.
Louise Pilote (Mon,) conducted a cohort in Acute myocardial infarction (n=518). Aggressive treatment (United States) vs. Conservative treatment (Canada) was evaluated on Mortality (p=>0.05). Aggressive treatment of US patients with myocardial infarction did not improve mortality (28% vs 27%) or reinfarction (13% vs 8%) compared to conservative treatment in Canadian patients (P>0.05).