DIFFERENCES IN THE TREATMENT OF MYOCARDIAL-INFARCTION BETWEEN THE UNITED-STATES AND CANADA - A SURVEY OF PHYSICIANS IN THE GUSTO TRIAL

Treatment of acute myocardial infarction differs between the United St ates and Canada, but the reasons for these practice pattern difference s remain elusive. To investigate whether physician beliefs and access to procedures account for these differences in the treatment of acute myocardial infarction, a random sample of physicians involved in the G lobal Utilization of Streptokinase and Tissue Plasminogen Activator fo r Occluded Coronary Arteries trial in the United States (n = 332) and Canada (n = 200) was surveyed. We found that American physicians recom mend coronary angiography after uncomplicated infarction significantly more (median: 7 versus 3 of 11 possible indications, P = 0.0001). Cor onary angiography, angioplasty, and bypass surgery were available in-h ospital to more American than Canadian physicians (77% versus 41%), an d the reported waiting period for cardiac procedures in a stable patie nt was longer in Canada (angiography: 28 versus 1.5 days; angioplasty: 30 versus 2 days; bypass surgery: 84 versus 3 days, all P < 0.001). M ore American than Canadian physicians were cardiologists (88% versus 7 4%), and more were interventional cardiologists (61% versus 26%). Amer ican physicians more highly rated the importance of patient requests, malpractice, and insurance coverage, whereas Canadians more highly rat ed availability of cardiac procedures as influencing clinical decision s. After statistical adjustment for these factors, however, Americans remained significantly more likely to recommend coronary angiography.