Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003
Abstract
Background
Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown.
Methods
From the National Registry of Myocardial Infarction, we identified 238,291 patients enrolled from June 1994 to May 2003 who were ideally suited for acute reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention. We determined rates of not receiving therapy across 3 time periods (June 1994-May 1997, June 1997-May 2000, June 2000-May 2003) and evaluated factors associated with underutilization.
Results
The proportion of ideal patients not receiving acute reperfusion therapy decreased by one half throughout the past decade (time period 1: 20.6%; time period 2: 11.4%; time period 3: 11.6%; P <.001). Utilization remained significantly lower in key subgroups in the most recent time period: those without chest pain (odds ratio [OR] 0.29; 95% confidence interval [CI], 0.27-0.32); those presenting 6 to 12 hours after symptom onset (OR 0.57; 95% CI, 0.52-0.61); those 75 years or older (OR 0.63 compared with patients <55 years old; 95% CI, 0.58-0.68); women (OR 0.88; 95% CI, 0.84-0.93); and non-whites (OR 0.90; 95% CI, 0.83-0.97).
Conclusions
Utilization of acute reperfusion therapy in ideal patients has improved over the last decade, but more than 10% remain untreated. Measuring and improving its use in this cohort represents an important opportunity to improve care.
eCenter for Cardiovascular Prevention, Research, and Education, Watson Clinic, Lakeland, Fla
fDivisions of Cardiovascular Diseases and Preventive Medicine, University of Alabama at Birmingham
gSection of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn
hCenter for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn.
Requests for reprints should be addressed to Harlan M. Krumholz, MD, SM, 333 Cedar St., Room I-456 SHM, PO Box 208088, New Haven, CT 06520-8088.
This project was supported by the National Heart, Lung, and Blood Institute (R01 HS072575). Genentech, Inc. (South San Francisco, CA) approved the study and provided access to National Registry of Myocardial Infarction (NRMI) data without charge.
ABSTRACT
