"In the two discordant groups, GP IIb/IIIa inhibitors were similarly used in less than 25 percent of the cases, while only slightly more than one-third of these patients received catheterization," Newby said. "This discrepancy occurs even though the troponin-positive/CK-MB-negative patients had a 4.45 percent death rate, compared to 2.95 percent rate for those who were troponin-negative/CK-MB-positive."

In 2001, Duke cardiologists showed that in terms of risk of future heart attacks, patients who were then considered lower risk -- those who were troponin-positive but CK-MB negative -- should in fact be treated as if they were high-risk patients.

"The results of out CRUSADE analysis shows that physicians -- for whatever reasons -- are not using therapies that we know can benefit high-risk patients," Newby said. "It is one of those cases where those who would stand to benefit the most from a therapy are not receiving it.

"As physicians, we don't always appreciate or interpret risk accurately," Newby continued. "One key to improving outcomes is for physicians to understand risk, and to understand that these therapies have been proven effective in clinical trials to reduce clinical events, particularly in high-risk patients."

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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
10-Mar-2004