1. 2006 CRUSADE 2nd Quarter Results

2. CRUSADE Site Distribution
Active sites = 400 WA
(5)
VT (1) ME
(0) MT
(0) ND
(1) MI
NH (1) MN
(3) OR
(6) NY
(31)
MA (10) SD
(2) WI
(7) ID
(0) MI
(21)
RI (1) WY
(0) PA
(38)
CT (7) IA
(6)
NJ (12)
NE (2) OH
(38)
DE (3) NV
(3) IL
(20) IN
(8) WV
(2) UT
(1) VA
(17)
MD (13) CO
(9) KS
(3) MO
(9) KY
(8)
DC (1) CA
(33) NC
(14) TN
(9) OK
(5) SC
(5) AZ
(8) AR
(2) NM
(1) AL
(8) GA
(10) MS
(6) LA
(6) TX
(16) FL
(29) AK
(0)
HI (0)
Last updated: 8/1/06

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

4. Baseline Characteristics: CRUSADE vs. ACS Clinical Trials
Variable PURSUIT CURE SYNERGY CRUSADE (n = 9461) (n = 12,562) (n = 9975) (n = 180,842)
Mean age ± SD (yrs) 63 ± ± ± ± 14
Female sex (%)
Diabetes mellitus (%)
Prior MI (%)
Prior CHF (%)
Prior PCI (%) 13 18* 20 21
Prior CABG (%) 12 18* 17 19
ST depression (%)
Update to end of 4th quarter CRUSADE data.
NEJM 1998;339:436-43
NEJM 2001;345:
JAMA 2004:292:45-54
CRUSADE cumulative through June 30, 2006

5. Hospital Presentation Characteristics in CRUSADE – Q2 2006
Qualifying Criteria
ST-segment depression 27% Transient ST-segment elevation % Positive cardiac markers 93%
Baseline cardiac markers Drawn Positive*
CK-MB 82% 73% TnT/TnI 99% 85%
Presenting Characteristics
Tachycardia 21% Hypotension 4%
Signs of CHF %
*Of subset drawn
Q CRUSADE data (n=6923)

6. Hospital Presentation Characteristics in CRUSADE- Last 12 Months
Qualifying Criteria
ST-segment depression 28% Transient ST-segment elevation % Positive cardiac markers 93%
Baseline cardiac markers Drawn Positive
CK-MB 82% 75% TnT/TnI 99% 91%
Presenting Characteristics
Tachycardia 22% Hypotension 4%
Signs of CHF %
CRUSADE DATA: July 1, 2005 – June 30, (n=31,665)

7. CRUSADE In-Hospital Outcomes : Last 12 Months
Death %
(Re)-Infarction %
CHF %
Cardiogenic Shock %
Stroke %
RBC Transfusion* %
*Excluding CABG-related transfusions
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)

8. CRUSADE vs. ACS Clinical Trials: Early Mortality Rates
In-hospital mortality rate
4.5%
7-day mortality rate
1.9%
1.8%
1.5%
PURSUIT1 (n = 9,461)
PRISM-PLUS2 (n = 1,915)
SYNERGY3
(n = 9,975)
CRUSADE (n = 180,842)
1.The PURSUIT Trial Investigators. N Engl J Med 1998
2.The PRISM-PLUS Study Investigators. N Engl J Med 1998
3. The Synergy Study JAMA 2004
CRUSADE cumulative data through 6/30/2006

9. Goal for CRUSADE: Improve Adherence to ACC/AHA Guidelines
Acute Therapy
Discharge Therapy
Aspirin
Clopidogrel
Beta Blocker
Heparin (UFH or LMWH)
GP IIb-IIIa Inhibitor
Cath/PCI
Aspirin
Clopidogrel
Beta Blocker
ACE Inhibitor
Statin/Lipid Lowering
Smoking Cessation
Cardiac Rehabilitation
2002 ACC/AHA Guidelines Update

10. Acute Medication Use – Q2 2006 (Within 1st 24 hours in patients without contraindications)
Q CRUSADE data (n=6923)

11. Acute Medication Use-Last 12 Months (Within 1st 24 hours in patients without contraindications)
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

12. Leading and Lagging Hospital Quartiles: Acute Care—1st 24 hours
Peterson et al, ACC 2004
Cumulative CRUSADE data through September 2003

13. Acute Medication Use by Gender: Last 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

14. Acute Medication Use by Age: Last 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

15. Invasive Cardiac Procedures – Q2 2006 (Among Patients Without Contraindications to Cath)
Q CRUSADE Data (n=6923)

16. Invasive Cardiac Procedures – Last 12 Months (Among Patients Without Contraindications to Cath)
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

17. Discharge Medication Use – Q2 2006 (In patients without contraindications)
*LVEF < 40%, CHF, DM, HTN # Known hyperlipidemia,  TC,  LDL
Q CRUSADE data (n=6923)

18. Discharge Medication Use – Last 12 Months (In patients without contraindications)
*LVEF < 40%, CHF, DM, HTN # Known hyperlipidemia,  TC,  LDL
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

19. Leading and Lagging Hospitals Quartiles: Discharge Care
* LVEF < 40%
# Known hyperlipidemia
Peterson et al, ACC 2004
Cumulative CRUSADE data through September 2003

20. Discharge Medication Use by Gender: Last 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

21. Discharge Medication Use by Age: Last 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

22. Discharge Care for CABG versus PCI Patients
Dyke et al, AHA 2004

23. Discharge Interventions – Q2 2006
Q CRUSADE data (n=6923)

24. Discharge Interventions- Last 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

25. Treatment by Renal Insufficiency
Han et al, AHA 2004

26. Outcomes by Renal Insufficiency
Han et al, AHA 2004

27. Trends in Acute Therapy Adherence
Quarter 3, 2005 through Quarter 2, 2006

28. Trends in Discharge Therapy Adherence
Quarter 3, 2005 through Quarter 2, 2006

29. Trends in Discharge Recommendations Adherence
Quarter 3, 2005 through Quarter 2, 2006

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

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

32. Link Between Overall Guidelines Adherence and Mortality
Peterson et al, ACC, 2004
Cumulative CRUSADE data through September 2003

33. Summary
NSTE ACS patients treated in routine practice are at higher risk than those enrolled in clinical trials.
While care better treatment gaps persist, especially in high-risk sub-groups.
Continued QI efforts are needed to improve guidelines adherence and sustain evidence-based care.

34. CRUSADE Continues to Evolve
Continued National/Regional QI Activities
New Emphasis on Drug Safety
Broad Dissemination of CRUSADE findings
Expansion to STEMI population (Optional)
Longitudinal F/U program (Optional)
Further Collaborations with Professional Societies (AHA GWTG Program)