USE OF EVIDENCE-BASED MEDICAL THERAPY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY REVASCULARIZATION IN THE UNITED-STATES, EUROPE, AND CANADA

The objective of this study was to examine whether there ore internati onal variations in the use of evidence-based medical therapy in patien ts undergoing percutaneous coronary revascularization. We analyzed the medical therapy of patients in the United States (US) (n = 878), Euro pe (n = 134), and Canada (n = 274) who underwent percutaneous coronary revascularization in either the Coronary Angioplasty Versus Excisiona l Atherectomy Trial (CAVEAT-I) (enrollment from August 1991 to April 1 992) or the Canadian Coronary Atherectomy Trial (CCAT) (enrollment fro m July 1991 to August 1992). We found that at the time of hospital adm ission, Canadian patients held the highest rates of treatment with asp irin (95% vs 57% US and 78% Europe; p = 0.002), calcium antagonists (7 5% vs 48% US and 43% Europe; p = 0.0001), beta blockers (60% vs 32% US and 46% Europe; p = 0.02), and combination anti-ischemic therapy (67% vs 43% US and 56% Europe; p = 0.0001). By discharge, however, Canadia n patients had the lowest rates of treatment with nitrates (12% vs 40% US and 44% Europe; p = 0.0001) and combination anti-ischemic therapy (29% vs 53% US and 47% Europe; p <0.01). At both admission and dischar ge, rates of treatment with angiotensin-converting enzyme inhibitors a nd lipid-lowering agents were <15% in all 3 regions. We conclude that significant international variations exist in the use of evidence-base d medical therapy in patients undergoing percutaneous coronary revascu larization. (C) 1997 by Excerpta Medica, Inc.