Few studies have compared acute myocardial infarction management in different countries. A cross-sectional cohort study was undertaken to quantify differences among countries in terms of treatment, outcomes, and measures of efficiency for patients who had ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Study participants were adults ages 66 and older who were admitted to the hospital for one day or longer with a primary diagnosis of acute myocardial infarction from 2011 to 2017 in six high-income countries (the United States, Canada, England, the Netherlands, Israel, and Taiwan).

In 2011, the use of percutaneous coronary intervention within 90 days of admission for patients who had STEMI was substantially higher in the United States and Canada than in the other countries and remained higher in 2017. Use of coronary artery bypass grafting after STEMI was also highest in the United States throughout the study period.

In 2017, use of percutaneous coronary intervention within 90 days of admission for patients who had NSTEMI differed by more than twofold between countries, ranging from 24.7% in the Netherlands to 52.7% in Taiwan. Use of coronary artery bypass grafting within 90 days of admission was highest in the United States and Canada in 2011, and also in 2017.

Mortality after STEMI and NSTEMI was higher in the United States and Taiwan than in the other countries in 2011 and 2017 at 30 days and at one year. Hospital efficiency also differed between countries. In 2017, mean length of stay for STEMI ranged from five days in the Netherlands to 8.5 days in Taiwan, and the 30-day readmission rate for STEMI ranged from 11.7% in Taiwan to 23.1% in England.

The study had several limitations: it relied on administrative data and lacked detailed clinical information, it didn't adjust for race or ethnicity, certain types of data were missing for some countries, and the findings may not apply to younger patients or those who have private insurance.

The authors conclude that although all countries had high performance in some areas, none excelled in all three domains, leaving room for improvement in each country studied.