COMPARISON BETWEEN JAPAN AND NORTH-AMERICA IN THE POST-HOSPITAL COURSE AFTER RECOVERY FROM AN ACUTE CORONARY EVENT

We compared the post-hospital prognosis after an acute coronary event (acute myocardial infarction and unstable angina) in 106 patients in J apan vs. 789 patients in North America who were prospectively enrolled in the Multicenter Study of Myocardial Ischemia and were followed-up for an average of 26 months per patients. Risk factors more frequent i n Japan were older age, males and smoking at enrolment, but the rest o f many risk factors were similar. After adjusting for differences in c linical and medication variables, Cox analyses indicated patients in N orth America had a significantly greater risk of experiencing a primar y end-point (cardiac death, non-fatal myocardial infarction or unstabl e angina) than patients in Japan (hazard ratio [North America:Japan] = 3.1, P = 0.003). There was a non-significant trend in the restricted end-points (cardiac death or non-fatal myocardial infarction) with Nor th America having more frequent events than Japan (hazard ratio = 2.2, P = 0.12). The long-term outcome after recovery from an acute coronar y event is more favorable in Japan than in North America, mostly due t o a reduction in subsequent hospitalization for unstable angina. The r eason for these findings cannot be explained by differences in the mea sured risk factors or medications.