PMID- 15588742
OWN - NLM
STAT- MEDLINE
DCOM- 20050426
LR  - 20071115
IS  - 0197-2456 (Print)
IS  - 0197-2456 (Linking)
VI  - 25
IP  - 6
DP  - 2004 Dec
TI  - Geographic variability in patient characteristics, treatment and outcome in an 
      International Trial of Magnesium in acute myocardial infarction.
PG  - 553-62
AB  - 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, including 
      history 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.
FAU - Domanski, Michael
AU  - Domanski M
AD  - The Clinical Trials Group, National Heart, Lung, and Blood Institute, 6701 
      Rockledge Drive, MSC 7936, Bethesda, MD 20892, USA. domanskm@nhlbi.nih.gov
FAU - Antman, Elliott M
AU  - Antman EM
FAU - McKinlay, Sonja
AU  - McKinlay S
FAU - Varshavsky, Sergei
AU  - Varshavsky S
FAU - Platonov, Pyotr
AU  - Platonov P
FAU - Assmann, Susan F
AU  - Assmann SF
FAU - Norman, James
AU  - Norman J
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Control Clin Trials
JT  - Controlled clinical trials
JID - 8006242
RN  - 0 (Calcium Channel Blockers)
RN  - 0 (Fibrinolytic Agents)
RN  - 7487-88-9 (Magnesium Sulfate)
SB  - IM
MH  - Aged
MH  - Angioplasty
MH  - Calcium Channel Blockers/*therapeutic use
MH  - Demography
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heart Failure/epidemiology
MH  - Humans
MH  - Hypertension/epidemiology
MH  - Incidence
MH  - *Internationality
MH  - Magnesium Sulfate/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/mortality/surgery
MH  - Prevalence
MH  - *Randomized Controlled Trials as Topic
MH  - Stroke/epidemiology
MH  - *Treatment Outcome
EDAT- 2004/12/14 09:00
MHDA- 2005/04/27 09:00
CRDT- 2004/12/14 09:00
PHST- 2004/03/22 00:00 [received]
PHST- 2004/08/01 00:00 [accepted]
PHST- 2004/12/14 09:00 [pubmed]
PHST- 2005/04/27 09:00 [medline]
PHST- 2004/12/14 09:00 [entrez]
AID - S0197-2456(04)00089-3 [pii]
AID - 10.1016/j.cct.2004.08.005 [doi]
PST - ppublish
SO  - Control Clin Trials. 2004 Dec;25(6):553-62. doi: 10.1016/j.cct.2004.08.005.