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ESC Congress 2003: Different outcomes in patients suffering from heart attacks among countries with different Gross National Income

September 01, 2003

IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

ESC Congress 2003: Recent publications suggested different outcomes in patients admitted to hospitals with heart attacks (acute myocardial infarction) between developed and developing countries.

In order to clarify this point, ECLA (Estudios Clinicos Latinoamerica) in collaboration with Vigour Group (Duke Clinical Research Institute, University of Leuven, Green Lane Hospital, NHMRC-Clinical Trials Centre, University of Alberta-CVC) performed a retrospective analysis of the databases of five clinical trials that included 50.310 patients suffering from heart attacks from 53 countries in the five continents.

The countries were stratified in 3 groups according to the Gross National Income (GNI) obtained from World Bank data: Low (less than US$ 2900), Medium (between US$ 2900 and 9000) and High (more than US$ 9000). The 30-day mortality rate (number of patients who died over 100 patients who were hospitalised due to a heart attack) was analysed in each group.

The mortality rate observed was inversely related to GNI, which means that mortality increases when the GNI decreases (Figure 1).

The clinical characteristics of the patients were different across the different country groups. Patients from lower and medium GNI countries were sicker than those in the high GNI group and therefore a higher mortality rate would be expected. However the mortality rate observed was higher than the expected in the low and medium GNI groups and lower than the expected in the high GNI group.

Figure 1


To explain the observed increased mortality, we analysed the treatment and the invasive procedures that these patients received while they were in hospital.

In countries with low or medium GNI a different type of thrombolytic was used and the time from symptom onset to thrombolytic administration was longer, compared to high GNI countries. Concomitant medication used in the low or medium GNI groups was as good as in the high group. As GNI increased more invasive procedures were performed but this fact was not related to a better outcome.

Our findings confirm that mortality rate is inversely correlated to GNI. This increase in mortality could be partially explained by differences in the clinical characteristics of the patients included. The type of or the time to thrombolityc administration needs a more exhaustive analyses. The concomitant medication as beta-blockers, aspirin or ACE inhibitors, or the use of revascularization procedures are not related to the increased mortality.

Given the fact that cardiovascular disease is increasing in developing countries which have a higher in-hospital mortality, our challenge is now to identify and try to modify the causes that lead to this high mortality in order to save more lives.

Andrés Orlandini MD
Estudios Cl'­nicos Latinoamérica
Argentine

European Society of Cardiology (ESC)