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CLINICAL STUDY: MYOCARDIAL INFARCTION

Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the U.S. from 1990 through 1999

The National Registry of Myocardial Infarction 1, 2 and 3

William J. Rogers, MD, FACC^*, John G. Canto, MD, MSPH, FACC^*, Costas T. Lambrew, MD, FACC, Alan J. Tiefenbrunn, MD, FACC, Becky Kinkaid, David A. Shoultz, PhD^||, Paul D. Frederick, MPH, MBA^||, Nathan Every, MD, MPH, FACC^|| for the Investigators in the National Registry of Myocardial Infarction 1 2 and 3^¶

^* University of Alabama Medical Center, Birmingham, Alabama, USA
Maine Medical Center, Portland, Maine, USA
Washington University School of Medicine, St. Louis, Missouri, USA
Genentech, Inc., South San Francisco, California, USA
^|| University of Washington, Seattle, Washington, USA

Manuscript received November 2, 1999; revised manuscript received May 31, 2000, accepted July 14, 2000.

Reprint requests and correspondence: Dr. William J. Rogers, 334 LHRB, University of Alabama Medical Center, Birmingham, Alabama 35294
wrogers{at}uab.edu

OBJECTIVES

We sought to determine trends in the treatment of myocardial infarction from 1990 through 1999 in the U.S. and to relate these trends to current guidelines.

BACKGROUND

Limited data are available to show how recent clinical trials and clinical guidelines have impacted treatment of myocardial infarction.

METHODS

Temporal trends in myocardial infarction treatment and outcome were assessed by using data from 1,514,292 patients in the National Registry of Myocardial Infarction (NRMI) 1, 2 and 3 from 1990 through 1999.

Results

During this interval, the use of intravenous thrombolytic therapy declined from 34.3% to 20.8%, but the use of primary angioplasty increased from 2.4% to 7.3% (both p = 0.0001). The median "door-to-drug" time among thrombolytic therapy recipients fell from 61.8 to 37.8 min (p = 0.0001), primarily owing to shorter "door-to-data" and "data-to-decision" times. The prevalence of non–Q wave infarctions increased from 45% in 1994 to 63% in 1999 (p = 0.0001). From 1994 through 1999, there was increased usage of beta-blockers, aspirin and angiotensin-converting inhibitors, both during the first 24 h after admission and on hospital discharge (all p = 0.0001). Between 1990 and 1999, the median duration of hospital stay fell from 8.3 to 4.3 days, and hospital mortality declined from 11.2% to 9.4% (both p = 0.0001).

CONCLUSIONS

The NRMI data from 1990 through 1999 demonstrate that the recommendations of recent clinical trials and published guidelines are being implemented, resulting in more rapid administration of intravenous thrombolytic therapy, increasing use of primary angioplasty and more frequent use of adjunctive therapies known to reduce mortality, and may be contributing to the higher prevalence of non–Q wave infarctions, shorter hospital stays and lower hospital mortality.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AMI = acute myocardial infarction   CABG = coronary artery bypass graft surgery   ECG = electrocardiogram or electrocardiographic   LBBB = left bundle branch block   IV = intravenous   NRMI = National Registry of Myocardial Infarction   PTCA = percutaneous transluminal coronary angioplasty   rt-PA = recombinant tissue-type plasminogen activator

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				J. W. Eikelboom, D. J. Quinlan, S. R. Mehta, A. G. Turpie, I. B. Menown, and S. Yusuf Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction: A Meta-Analysis of the Randomized Trials Circulation, December 20, 2005; 112(25): 3855 - 3867. [Abstract] [Full Text] [PDF]

				C. Patrono, L. A. Garcia Rodriguez, R. Landolfi, and C. Baigent Low-dose aspirin for the prevention of atherothrombosis. N. Engl. J. Med., December 1, 2005; 353(22): 2373 - 2383. [Full Text] [PDF]

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				J. G. Robinson, B. Smith, N. Maheshwari, and H. Schrott Pleiotropic Effects of Statins: Benefit Beyond Cholesterol Reduction?: A Meta-Regression Analysis J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1855 - 1862. [Abstract] [Full Text] [PDF]

				R C Welsh, W Chang, P Goldstein, J Adgey, C B Granger, F W A Verheugt, L Wallentin, F Van de Werf, P W Armstrong, and on behalf of the ASSENT-3 PLUS Investigators Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction: insights from the ASSENT-3 PLUS trial Heart, November 1, 2005; 91(11): 1400 - 1406. [Abstract] [Full Text] [PDF]

				W. A. Jaber, R. J. Lennon, V. Mathew, D. R. Holmes Jr, A. Lerman, and C. S. Rihal Application of Evidence-Based Medical Therapy Is Associated With Improved Outcomes After Percutaneous Coronary Intervention and Is a Valid Quality Indicator J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1473 - 1478. [Abstract] [Full Text] [PDF]

				K. A. Eagle, C. K. Montoye, A. L. Riba, A. C. DeFranco, R. Parrish, S. Skorcz, P. L. Baker, J. Faul, S. M. Jani, B. Chen, et al. Guideline-Based Standardized Care Is Associated With Substantially Lower Mortality in Medicare Patients With Acute Myocardial Infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1242 - 1248. [Abstract] [Full Text] [PDF]

				T. J. Meine, M. R. Patel, V. DePuy, L. H. Curtis, S. V. Rao, B. J. Gersh, K. A. Schulman, and J. G. Jollis Evidence-Based Therapies and Mortality in Patients Hospitalized in December with Acute Myocardial Infarction Ann Intern Med, October 4, 2005; 143(7): 481 - 485. [Abstract] [Full Text] [PDF]

				R. Aazami Initial Appraisal of Acute Coronary Syndromes Journal of Pharmacy Practice, October 1, 2005; 18(5): 377 - 393. [Abstract] [PDF]

				D. J. Moliterno and S. R. Steinhubl Clopidogrel for Percutaneous Coronary Revascularization: Time for More Pretreatment, Retreatment, or Both? JAMA, September 14, 2005; 294(10): 1271 - 1273. [Full Text] [PDF]

				V. Vaccarino, S. S. Rathore, N. K. Wenger, P. D. Frederick, J. L. Abramson, H. V. Barron, A. Manhapra, S. Mallik, H. M. Krumholz, and the National Registry of Myocardial Infarction Inv Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002 N. Engl. J. Med., August 18, 2005; 353(7): 671 - 682. [Abstract] [Full Text] [PDF]

				A. Babaev, P. D. Frederick, D. J. Pasta, N. Every, T. Sichrovsky, J. S. Hochman, and for the NRMI Investigators Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock JAMA, July 27, 2005; 294(4): 448 - 454. [Abstract] [Full Text] [PDF]

				M. T. Roe, L. S. Parsons, C. V. Pollack Jr, J. G. Canto, H. V. Barron, N. R. Every, W. J. Rogers, E. D. Peterson, and for the National Registry of Myocardial Infarction Quality of Care by Classification of Myocardial Infarction: Treatment Patterns for ST-Segment Elevation vs Non-ST-Segment Elevation Myocardial Infarction Arch Intern Med, July 25, 2005; 165(14): 1630 - 1636. [Abstract] [Full Text] [PDF]

				E. M. Ohman and P. P. Chang Improving Quality of Life After Cardiogenic Shock: Do More Revascularization! J. Am. Coll. Cardiol., July 19, 2005; 46(2): 274 - 276. [Full Text] [PDF]

				A-A Fassa, P Urban, D Radovanovic, N Duvoisin, J-M Gaspoz, J-C Stauffer, P Erne, and for the AMIS Plus Investigators Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry Heart, July 1, 2005; 91(7): 882 - 888. [Abstract] [Full Text] [PDF]

				A. Schomig, J. Mehilli, D. Antoniucci, G. Ndrepepa, C. Markwardt, F. Di Pede, S. G. Nekolla, K. Schlotterbeck, H. Schuhlen, J. Pache, et al. Mechanical Reperfusion in Patients With Acute Myocardial Infarction Presenting More Than 12 Hours From Symptom Onset: A Randomized Controlled Trial JAMA, June 15, 2005; 293(23): 2865 - 2872. [Abstract] [Full Text] [PDF]

				B. J. Gersh, G. W. Stone, H. D. White, and D. R. Holmes Jr Pharmacological Facilitation of Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Is the Slope of the Curve the Shape of the Future? JAMA, February 23, 2005; 293(8): 979 - 986. [Abstract] [Full Text] [PDF]

				B. K. Nallamothu, E. R. Bates, J. Herrin, Y. Wang, E. H. Bradley, H. M. Krumholz, and for the NRMI Investigators Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 Analysis Circulation, February 15, 2005; 111(6): 761 - 767. [Abstract] [Full Text] [PDF]

				N. Valeur, P. Clemmensen, K. Saunamaki, P. Grande, and for the DANAMI-2 investigators The prognostic value of pre-discharge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI-2 sub-study Eur. Heart J., January 2, 2005; 26(2): 119 - 127. [Abstract] [Full Text] [PDF]

				C. J. Terkelsen, J. F. Lassen, B. L. Norgaard, J. C. Gerdes, T. Jensen, L. B.-H. Gotzsche, T. T. Nielsen, and H. R. Andersen Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort Eur. Heart J., January 1, 2005; 26(1): 18 - 26. [Abstract] [Full Text] [PDF]