2006 CRUSADE 2 nd Quarter Results

2006 CRUSADE 22006 CRUSADE 2ndnd Quarter Results Quarter Results

Last updated: 8/1/06

Active sites = 400

AK(0)

WA(5)

OR(6)

CA(33)

ID(0)

NV(3)

MT(0)

WY(0)

CO(9)

NM(1)

ND(1)

SD(2)

NE (2)

KS(3)

OK(5)

TX(16)

MN(3)

IA(6)

MO(9)

AR(2)

LA(6)

WI(7) MI

(21)

MI

UT(1)

AZ(8)

HI (0)

IL(20)

IN(8)

KY(8)

TN(9)

MS(6)

AL(8)

GA(10)

FL(29)

SC(5)

NC(14)

VA(17)

OH(38)

WV(2)

PA(38)

NY(31)

MD (13)

ME(0)

VT (1)

NH (1)

NJ (12)

MA (10)

CT (7)

DE (3)

RI (1)

DC (1)

CRUSADE Site DistributionCRUSADE Site Distribution

CRUSADE Cumulative CRUSADE Cumulative Data Submission (n= 180,842)Data Submission (n= 180,842)

138716

148147156742

165498172763

180842

50000

70000

90000

110000

130000

150000

170000

190000

Mar-05 Jun-05 Sep-05 Dec-05 Mar-06 Jun-06

Baseline Characteristics:Baseline Characteristics:CRUSADE vs. ACS Clinical TrialsCRUSADE vs. ACS Clinical Trials

VariableVariable PURSUITPURSUIT CURECURE SYNERGYSYNERGY CRUSADECRUSADE(n = 9461)(n = 9461) (n = 12,562)(n = 12,562) (n = 9975)(n = 9975) (n = 180,842)(n = 180,842)

Mean age ± SD (yrs)Mean age ± SD (yrs) 63 ± 1163 ± 11 63 ± 1263 ± 12 67 ± 1167 ± 11 67 ± 1467 ± 14

Female sex (%)Female sex (%) 3636 3939 3434 4040

Diabetes mellitus (%)Diabetes mellitus (%) 2323 2323 2929 3333

Prior MI (%)Prior MI (%) 3232 2525 2828 3030

Prior CHF (%)Prior CHF (%) 1111 88 99 1818

Prior PCI (%)Prior PCI (%) 1313 18*18* 2020 2121

Prior CABG (%)Prior CABG (%) 1212 18*18* 1717 1919

ST depression (%)ST depression (%) 5050 4242 5555 3434

NEJM 1998;339:436-43NEJM 1998;339:436-43NEJM 2001;345:494-502NEJM 2001;345:494-502JAMA 2004:292:45-54JAMA 2004:292:45-54CRUSADE cumulative through June 30, 2006CRUSADE cumulative through June 30, 2006

NEJM 1998;339:436-43NEJM 1998;339:436-43NEJM 2001;345:494-502NEJM 2001;345:494-502JAMA 2004:292:45-54JAMA 2004:292:45-54CRUSADE cumulative through June 30, 2006CRUSADE cumulative through June 30, 2006

Hospital PresentationHospital PresentationCharacteristics in CRUSADE – Q2 2006Characteristics in CRUSADE – Q2 2006

Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 27% 27%Transient ST-segment elevationTransient ST-segment elevation 4% 4%Positive cardiac markersPositive cardiac markers 93% 93%

Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositive*Positive*

CK-MBCK-MB 82%82%73%73%TnT/TnITnT/TnI 99%99%85%85%

Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 21%21%HypotensionHypotension 4% 4%Signs of CHF 22%Signs of CHF 22%


Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositive*Positive*


Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 21%21%HypotensionHypotension 4% 4%Signs of CHF 22%Signs of CHF 22%*Of subset drawn

Q2 2006 CRUSADE data (n=6923)

Hospital PresentationHospital PresentationCharacteristics in CRUSADE-Characteristics in CRUSADE-

Last 12 MonthsLast 12 Months Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 28% 28%Transient ST-segment elevationTransient ST-segment elevation 5% 5%Positive cardiac markersPositive cardiac markers 93% 93%

Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositivePositive




Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositivePositive



CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

CRUSADE In-Hospital Outcomes : CRUSADE In-Hospital Outcomes : Last 12 MonthsLast 12 Months

Death Death 3.9% 3.9%

(Re)-Infarction (Re)-Infarction 1.8% 1.8%

CHF CHF 7.0% 7.0%

Cardiogenic Shock Cardiogenic Shock 2.2% 2.2%

Stroke Stroke 0.6% 0.6%

RBC Transfusion*RBC Transfusion* 9.4% 9.4%

*Excluding CABG-related transfusionsCRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)*Excluding CABG-related transfusionsCRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)

CRUSADE vs. ACS Clinical Trials:CRUSADE vs. ACS Clinical Trials:Early Mortality RatesEarly Mortality Rates

0

1

2

3

4

5

6

0

1

2

3

4

5

6

PURSUITPURSUIT11 (n = 9,461)(n = 9,461)

PRISM-PLUSPRISM-PLUS22 (n = 1,915)(n = 1,915)

SYNERGYSYNERGY33

(n = 9,975)(n = 9,975)CRUSADE CRUSADE

(n = 180,842)(n = 180,842)

1.8%1.8% 1.9%1.9%1.5%1.5%

4.54.5%%

7-day mortality rate7-day mortality rate

In-hospital mortality rate

In-hospital mortality rate

1.The PURSUIT Trial Investigators. N Engl J Med 1998 2.The PRISM-PLUS Study Investigators. N Engl J Med 19983. The Synergy Study JAMA 2004 CRUSADE cumulative data through 6/30/2006

1.The PURSUIT Trial Investigators. N Engl J Med 1998 2.The PRISM-PLUS Study Investigators. N Engl J Med 19983. The Synergy Study JAMA 2004 CRUSADE cumulative data through 6/30/2006

Goal for CRUSADE: Goal for CRUSADE: Improve Adherence to ACC/AHA GuidelinesImprove Adherence to ACC/AHA Guidelines

AspirinAspirin ClopidogrelClopidogrel

Beta BlockerBeta Blocker

Heparin (Heparin (UFH or LMWHUFH or LMWH))

GP IIb-IIIa InhibitorGP IIb-IIIa Inhibitor Cath/PCICath/PCI

AspirinAspirin

ClopidogrelClopidogrel

Beta BlockerBeta Blocker

ACE Inhibitor ACE Inhibitor

Statin/Lipid LoweringStatin/Lipid Lowering

Smoking CessationSmoking Cessation

Cardiac RehabilitationCardiac Rehabilitation

Acute TherapyAcute TherapyAcute TherapyAcute Therapy Discharge TherapyDischarge TherapyDischarge TherapyDischarge Therapy

2002 ACC/AHA Guidelines Update

Acute Medication Use – Q2 2006Acute Medication Use – Q2 2006(Within 1st 24 hours in patients without contraindications)(Within 1st 24 hours in patients without contraindications)

Q2 2006 CRUSADE data (n=6923)Q2 2006 CRUSADE data (n=6923)

96% 92%87%

45%

60%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers Heparin(LMW+UFH)

GP llb-lllaInhibitors

Clopidogrel

Acute Medication Use-Last 12 MonthsAcute Medication Use-Last 12 Months(Within 1st 24 hours in patients without contraindications)(Within 1st 24 hours in patients without contraindications)


96%91%

83%

46%

59%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UHF)

GP llb-lllaInhibitors

Clopidogrel

Leading and Lagging Hospital Leading and Lagging Hospital Quartiles: Acute Care—1Quartiles: Acute Care—1stst 24 hours 24 hours

96%87% 90%

50%

85%

66% 66%

17%

0%

20%

40%

60%

80%

100%

Aspirin Beta Blockers Heparin GP IIb-IIIa

Leading Centers

Lagging Centers

Peterson et al, ACC 2004Peterson et al, ACC 2004Cumulative CRUSADE data through September 2003Cumulative CRUSADE data through September 2003

Acute Medication Use by Gender: Acute Medication Use by Gender: Last 12 MonthsLast 12 Months

97%

61%

92%85%

50%

96%

55%

91%

80%

39%

0%

20%

40%

60%

80%

100%

Aspirin Clopidogrel BetaBlockers

Heparin GP IIb-IIIa

Male Female


Acute Medication Use by Age: Acute Medication Use by Age: Last 12 MonthsLast 12 Months

97%

61%

92%86%

52%

95%

53%

90%

76%

32%

0%

20%

40%

60%

80%

100%

Aspirin Clopidogrel BetaBlockers

Heparin GP IIb-IIIa

<75 75+


Invasive Cardiac Procedures – Q2 2006Invasive Cardiac Procedures – Q2 2006(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)

Invasive Cardiac Procedures – Q2 2006Invasive Cardiac Procedures – Q2 2006(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)

Q2 2006 CRUSADE Data (n=6923)

84%

68%

54%

44%

11%

0%

20%

40%

60%

80%

100%

Cath Cath<48hr

PCI PCI <48hr CABG


Invasive Cardiac Procedures – Last 12 MonthsInvasive Cardiac Procedures – Last 12 Months(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)

Invasive Cardiac Procedures – Last 12 MonthsInvasive Cardiac Procedures – Last 12 Months(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)

83%

67%

53%

38%

12%

0%

20%

40%

60%

80%

100%

Cath Cath<48hr

PCI PCI <48hr CABG

Discharge Medication Use – Q2 2006 Discharge Medication Use – Q2 2006 (In patients without contraindications)(In patients without contraindications)

*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia, TC, LDLQ2 2006 CRUSADE data (n=6923)

96% 94%

65%

90%

73%

0%

20%

40%

60%

80%

100%

120%

ASA BetaBlockers

Ace-Inhibitors*

Any LipidLoweringAgent#

Clopidogrel

*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia, TC, LDL CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

Discharge Medication Use – Last 12 Months Discharge Medication Use – Last 12 Months

(In patients without contraindications)(In patients without contraindications)

95% 93%

65%

89%

74%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Ace-Inhibitors*

Any LipidLoweringAgent#

Clopidogrel

Leading and Lagging Leading and Lagging Hospitals Quartiles: Discharge CareHospitals Quartiles: Discharge Care

94% 91%

70%

83%

62%

80%

71%

48%

62%

38%

0%

20%

40%

60%

80%

100%

D/C ASA D/C BB D/C ACE# Statin* Clopidogrel

Leading Centers Lagging Centers

* * LVEF < 40%LVEF < 40%## Known hyperlipidemia Known hyperlipidemia Peterson et al, ACC 2004Peterson et al, ACC 2004 Cumulative CRUSADE data through September 2003Cumulative CRUSADE data through September 2003

Discharge Medication Use by Gender: Discharge Medication Use by Gender: Last 12 MonthsLast 12 Months

96% 94%

63%

86%77%

94% 92%

60%

80%70%

0%

20%

40%

60%

80%

100%

120%

Aspirin Beta Blocker AceInhibitor

Statin Clopidogrel

Male Female


Discharge Medication Use by Age: Discharge Medication Use by Age: Last 12 MonthsLast 12 Months

96% 93%

62%

87%77%

94% 93%

61%

77%68%

0%

20%

40%

60%

80%

100%

120%

Aspirin Beta Blocker AceInhibitor

Statin Clopidogrel

<75 75+


Discharge Care for Discharge Care for CABG versus PCI PatientsCABG versus PCI Patients

Dyke et al, AHA 2004

95%88%

65%

76% 73% 72%

51%

79%

92%83%

44%

62%68%

86%

0%

20%

40%

60%

80%

100%

ASA BB ACE Statins SmokeCess

Counsel

CardiacRehab

Diet Mod

PCI (n=25,653) CABG (n=7663)

95%88%

65%

76% 73% 72%

51%

79%

92%83%

44%

62%68%

86%

0%

20%

40%

60%

80%

100%

ASA BB ACE Statins SmokeCess

Counsel

CardiacRehab

Diet Mod

PCI (n=25,653) CABG (n=7663)

Discharge Interventions – Q2 2006Discharge Interventions – Q2 2006

Q2 2006 CRUSADE data (n=6923)

69%

85%

64%

90%

0%

20%

40%

60%

80%

100%

Lipid Panel DietaryCounseling

CardiacRehab

Referral

SmokingCessation

Counseling

Discharge Interventions-Discharge Interventions-Last 12 MonthsLast 12 Months


69%

85%

66%

89%

0%

20%

40%

60%

80%

100%

Lipid PanelDrawn

DietaryCounseling

CardiacRehab

Referral

SmokingCessation

Counseling

Treatment by Renal Insufficiency Treatment by Renal Insufficiency

Han et al, AHA 2004

78.5%

37.4%42.8%

83.7%

52.3%

30.1%

12.8%

92.6%

6.9%10.8%

23.4%

76.7%

33.8%

19.6%

77.8%

89.3%

0%

20%

40%

60%

80%

100%

No RI (n=38,783) RI (n=6,560)

78.5%

37.4%42.8%

83.7%

52.3%

30.1%

12.8%

92.6%

6.9%10.8%

23.4%

76.7%

33.8%

19.6%

77.8%

89.3%

0%

20%

40%

60%

80%

100%

No RI (n=38,783) RI (n=6,560)

Outcomes by Renal InsufficiencyOutcomes by Renal Insufficiency

Han et al, AHA 2004

3.6% 2.7% 2.3%

8.1%

12.9%

27.4%

38.6%

46.9%

16.5%

24.7%

0%

10%

20%

30%

40%

50%

Death Reinfarction CardiogenicShock

CHF Transfusion

No RI (n=38,783) RI (n=6,560)

3.6% 2.7% 2.3%

8.1%

12.9%

27.4%

38.6%

46.9%

16.5%

24.7%

0%

10%

20%

30%

40%

50%

Death Reinfarction CardiogenicShock

CHF Transfusion

No RI (n=38,783) RI (n=6,560)

Trends in Acute Therapy AdherenceTrends in Acute Therapy Adherence

Quarter 3, 2005 through Quarter 2, 2006

96%90%

84%

46%

97% 93%88%

50%

0%

25%

50%

75%

100%

Antiplatelet Beta Blocker Heparin GP IIb- IIIaInhibitor

Q3-05 Q4-05 Q1-06 Q2-06

Trends in Discharge Therapy Trends in Discharge Therapy AdherenceAdherence

94%

72%

91%

64%

89%

74%

94%

66%

88%95%

0%

25%

50%

75%

100%

Aspirin Clopidogrel Beta Blocker ACEInhibitor

Lipid-Lowering

Agent

Q3-05 Q4-05 Q1-06 Q2-06


Trends in Discharge Recommendations Trends in Discharge Recommendations AdherenceAdherence

84%81%

62%

84%

62%

92%

0%

25%

50%

75%

100%

Smoking CessationCounseling

Dietary Modification Cardiac RehabilitationReferral

Q3-05 Q4-05 Q1-06 Q2-06


Composite Adherence Trends Over TimeComposite Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006Quarter 1, 2002 – Quarter 2, 2006

0%

20%

40%

60%

80%

100%

Q1'02

Q1'03

Q1'04

Q1'05

Q2'06

Acute

Discharge

0%

20%

40%

60%

80%

100%

Q1'02

Q1'03

Q1'04

Q1'05

Q2'06

Acute

Discharge

Overall Adherence Trends Over Time Overall Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006Quarter 1, 2002 – Quarter 2, 2006

68.1%73.0%

78.0%80.8% 83.2%

0%

25%

50%

75%

100%

Q1'02

Q1'03

Q1'04

Q1'05

Q2'06

68.1%73.0%

78.0%80.8% 83.2%

0%

25%

50%

75%

100%

Q1'02

Q1'03

Q1'04

Q1'05

Q2'06

Link Between Overall Link Between Overall Guidelines Adherence and MortalityGuidelines Adherence and Mortality

Peterson et al, ACC, 2004Cumulative CRUSADE data through September 2003

5.95

5.16 4.97

4.16

5.074.63

4.17

6.33

0

1

2

3

4

5

6

7

<=25% 25 - 50% 50 - 75% >=75%

Hospital Composite Quality Quartiles

% I

n-H

osp

Mo

rtali

ty

Adjusted Unadjusted

5.95

5.16 4.97

4.16

5.074.63

4.17

6.33

0

1

2

3

4

5

6

7

<=25% 25 - 50% 50 - 75% >=75%

Hospital Composite Quality Quartiles

% I

n-H

osp

Mo

rtali

ty

Adjusted Unadjusted

SummarySummary

NSTE ACS patients treated in routine practice are NSTE ACS patients treated in routine practice are at higher risk than those enrolled in clinical at higher risk than those enrolled in clinical trials.trials.

While care better treatment gaps persist, While care better treatment gaps persist, especially in high-risk sub-groups.especially in high-risk sub-groups.

Continued QI efforts are needed to improve Continued QI efforts are needed to improve guidelines adherence and sustain evidence-guidelines adherence and sustain evidence-based care.based care.

CRUSADE Continues to EvolveCRUSADE Continues to Evolve

Continued National/Regional QI ActivitiesContinued National/Regional QI Activities

New Emphasis on Drug SafetyNew Emphasis on Drug Safety

Broad Dissemination of CRUSADE findingsBroad Dissemination of CRUSADE findings

Expansion to STEMI population (Optional)Expansion to STEMI population (Optional)

Longitudinal F/U program (Optional) Longitudinal F/U program (Optional)

Further Collaborations with Professional Further Collaborations with Professional Societies (AHA GWTG Program)Societies (AHA GWTG Program)

Documents

2006 CRUSADE 2 nd Quarter Results