CLINICAL STUDIES
Use of angiotensin-converting enzyme inhibitors at discharge in patients with acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2
Hal V. Barron, MD, FACC*  ,
Andrew D. Michaels, MD*,
Charles Maynard, PhD ,
Nathan R. Every, MD, MPH for the National Registry of Myocardial Infarction 2 Participants
* Department of Medicine, Division of Cardiology, University of California–San Francisco Medical Center, San Francisco, California, USA
Genentech, Inc., South San Francisco, California, USA
Myocardial Infarction Triage and Intervention (MITI) Coordinating Center, Seattle, Washington, USA
Manuscript received August 12, 1997;
revised manuscript received March 30, 1998,
accepted April 17, 1998.
Address for correspondence: Dr. Hal V. Barron, Genentech, Inc., 460 Point San Bruno Boulevard, South San Francisco, California 94080-4990
barron{at}ep4.ucsf.edu
Objectives: This study was undertaken to examine recent trends in the use of angiotensin-converting enzyme (ACE) inhibitor therapy in patients discharged after acute myocardial infarction (AMI) and to identify clinical factors associated with ACE inhibitor prescribing patterns.
Background: Clinical trials have demonstrated a significant mortality benefit in patients treated with ACE inhibitors after AMI. Numerous studies have demonstrated underuse of other beneficial treatments for patients with AMI, such as beta-adrenergic blocking agents, aspirin and immediate reperfusion therapy.
Methods: Demographic, procedural and discharge medication data from 190,015 patients with AMI were collected at 1,470 U.S. hospitals participating in the National Registry of Myocardial Infarction 2.
Results: Prescriptions for ACE inhibitor therapy at hospital discharge increased from 25.0% in 1994 to 30.7% in 1996. Patients with a left ventricular ejection fraction  40% or evidence of congestive heart failure while in the hospital were discharged with ACE inhibitor treatment 42.6% of the time. Of patients experiencing an anterior wall myocardial infarction and no evidence of heart failure, 26.1% of patients were discharged with this treatment. Of the remaining patients, 15.6% received ACE inhibitors at discharge. ACE inhibitors were prescribed more often to elderly and diabetic patients as well as those requiring intraaortic balloon pump placement. This therapy was given less often to patients who underwent revascularization with coronary angioplasty or coronary artery bypass graft surgery or were treated with calcium channel blocking agents.
Conclusions: Physicians are prescribing ACE inhibitors in patients with myocardial infarction with increasing frequency. Those patients with the greatest expected benefit receive ACE inhibitor treatment most often. However, the majority of even these high risk patients were not discharged with this life-saving therapy.
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Abbreviations and Acronyms
| | ACC | = American College of Cardiology | | ACE | = angiotensin-converting enzyme | | AHA | = American Heart Association | | AMI | = acute myocardial infarction | | CABG | = coronary artery bypass graft surgery | | CCP | = Cooperative Cardiovascular Project | | ECG | = electrocardiographic | | LVEF | = left ventricular ejection fraction | | NRMI 2 | = National Registry of Myocardial Infarction 2 | | PTCA | = percutaneous transluminal coronary angioplasty |
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