Importance of ethnic differences in affecting the outcomes of international trials.

As cardiological trials become globalized, significant geographic variations in clinical outcomes become apparent, as was pointed out by the InTIME-II study and the accompanying editorial by van de Werf. The latter enumerated several factors among which ethnicity was thought to be an important demographic determinant of outcome. Van de Werf put forth the conjecture that ‘lower doses of fibrin specific agents are probably (my italics) sufficient in Asian patients.’. The last supposition was recently confirmed by the TPA/Urokinase Comparisons in China (TUCC) trial. In that exclusive Chinese population of patients with acute myocardial infarction, a reduced dose of only 50 mg of recombinant tissue plasminogen activator (rtPA) produced infarctartery patency (flow grades 2 or 3