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Background/Introduction: Inter-country comparisons can serve as natural experiments to assess the effectiveness of alternative systems of care for homogenous patient populations.

Purpose: We evaluated differences in clinical characteristics, reperfusion strategies employed, and clinical outcomes of patients hospitalized with an ST-elevation myocardial infarction (STEMI) in Canada and the United Kingdom (UK).

Methods: We compared 6,547 Albertans and 1,345 Northern England patients hospitalized for STEMI from 2009 to 2013 enrolled in the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies (COAPT) and Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) registries, respectively.

Results: As seen in the Table, Alberta patients were similar in age, but had fewer females than patients in the UK. Rates of hypertension and diabetes were higher in Alberta, but rates of heart failure and atrial fibrillation were higher in the UK cohort. A pharmacoinvasive (PI) approach (fibrinolysis + PCI) was used more frequently in Alberta while the majority of UK patients received primary percutaneous coronary intervention (PPCI). Almost 30% of patients received no reperfusion in Alberta. Median length of stay (LOS) was shorter in the UK. In a multivariable logistic regression model, there was no difference in 30-day mortality between the two regions (adjusted OR (aOR) 0.86, 95% CI 0.64–1.16, p=0.32). Shorter LOS was associated with reduced 30-day mortality (OR 0.89, 95% CI 0.87–0.92, p<0.01). There was a trend towards PI strategy being associated with lower risk (aOR 0.68, 95% CI 0.45–1.04, p=0.08), while no reperfusion was associated with a higher risk of 30-day mortality (aOR 2.16, 95% CI 1.69–2.76, p<0.001) compared to PPCI.

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Abstracts > Tuesday 28 August 2018
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