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J Am Coll Cardiol, 2000; 36:2056-2063
© 2000 by the American College of Cardiology Foundation
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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{dagger}, Alan J. Tiefenbrunn, MD, FACC{ddagger}, 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
{dagger} Maine Medical Center, Portland, Maine, USA
{ddagger} 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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