Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: Results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial

Background Although more than 9500 patients have been enrolled in molar cli nical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated For acute coronary syndromes in Latin Ame rica with those in North America. Methods The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Usin g Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST- segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient grou ps, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. Results For patients in Latin America, the length of hospital stay was sign ificantly longer (10 [7, 15] days vs 6 [4, 9], P<.001). Angiograms, angiopl asty, and bypass surgery were significantly less common in Latin America (4 6.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P<.001). Thirty-day deat h/myocardial infarction was not significantly higher, although mortality al one was significantly higher (6.8% vs 3.1%, P<.001). After adjustment for b aseline characteristics, enrollment in Latin America remained on independen t predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4 ]). Conclusions Latin American patients treated for acute coronary syndromes we re managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not exp lained by imbalances in baseline risk.