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首页> 外文期刊>Controlled clinical trials >Geographic variability in patient characteristics, treatment and outcome in an International Trial of Magnesium in acute myocardial infarction.
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Geographic variability in patient characteristics, treatment and outcome in an International Trial of Magnesium in acute myocardial infarction.

机译：急性心肌梗死国际镁试验中患者特征，治疗和预后的地理变异性。

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BACKGROUND: The interpretation of clinical trials and efforts directed at reducing the worldwide burden of coronary disease must take regional differences into account. This study examined the regional differences in baseline characteristics, treatment, and outcome in patients presenting with ST elevation myocardial infarction (STEMI) who were entered into the Magnesium in Coronaries (MAGIC) trial. METHODS AND RESULTS: MAGIC randomized 6213 patients to standard care with either placebo infusion or infusion of intravenous magnesium sulphate. There was no difference in mortality between these groups. For this analysis, three geographic regions were identified (Region 1=United States and Canada; Region 2=Bulgaria, Georgia, and Russia; Region 3=Austria, Belgium, Chile, Hungary, Israel, the Netherlands, New Zealand, and Venezuela) and compared with respect to baseline characteristics, treatment, and 30-day mortality. Patients in Region 2 had the highest prevalence of adverse risk factors at entry, includinghistory of prior myocardial infarction, heart failure, stroke, and hypertension; anterior location of index acute myocardial infarction; and presence of pulmonary congestion at presentation. Furthermore, Region 2 patients infrequently received reperfusion therapy compared with those in Region 1. Region 3 was intermediate in this regard. Mortality was highest in Region 2, least in Region 1, and intermediate in Region 3. CONCLUSION: Geographic location, particularly, parts of Eastern Europe, is strongly and independently associated with mortality following STEMI. This geographic variation in mortality confirms prior reports, although adequate explanations continue to be elusive and are beyond the scope of this large simple trial. Future international trials must recognize this variation in design, analysis, and interpretation.
机译：背景：对旨在减轻全球冠心病负担的临床试验和努力的解释必须考虑到地区差异。这项研究检查了参加冠心镁试验（MAGIC）的ST抬高型心肌梗死（STEMI）患者基线特征，治疗和预后的区域差异。方法和结果：MAGIC将6213例患者随机分为接受安慰剂输注或静脉注射硫酸镁输注的标准治疗。这些组之间的死亡率没有差异。为了进行此分析，确定了三个地理区域（区域1 =美国和加拿大;区域2 =保加利亚，乔治亚州和俄罗斯;区域3 =奥地利，比利时，智利，匈牙利，以色列，荷兰，新西兰和委内瑞拉）并比较了基线特征，治疗和30天死亡率。 2区患者进入时的不良危险因素患病率最高，包括既往心肌梗塞，心力衰竭，中风和高血压的病史;急性心肌梗死前位表现为肺充血。此外，与区域1相比，区域2的患者很少接受再灌注治疗。死亡率在2区最高，在1区最低，在3区中级。结论：地理位置，尤其是东欧部分地区，与STEMI后的死亡率密切相关。死亡率的这种地理差异证实了先前的报道，尽管仍然没有足够的解释，并且超出了这个大型简单试验的范围。未来的国际试验必须认识到设计，分析和解释上的这种差异。

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