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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

View larger version (28K): [in a new window]   Figure 1 Use of reperfusion therapy in all patients and in those presenting with ST segment elevation or LBBB within 12 h of symptom onset. A, A total of 1,514,292 patients were enrolled in NRMI 1, 2 and 3. B, A total of 376,753 patients in NRMI 2 and 3 presented with ST segment elevation or LBBB within 12 h of symptom onset. Either = either IV lytic or primary PTCA; IV lytic = intravenous thrombolytic therapy.

View larger version (27K): [in a new window]   Figure 2 Door-to-drug intervals. A, Door-to-drug interval in 295,056 patients treated with rt-PA. Although the time to treatment shortened significantly, it did not achieve the goal of 30 min. B, Door-to-drug subintervals in 266,177 patients treated with all IV thrombolytic agents.

View larger version (34K): [in a new window]   Figure 3 Medication (Meds) usage during first 24 h after hospital admission among 1,161,550 patients in NRMI 2 and 3. Ca blocker = calcium channel blocker; TNG = nitroglycerin.

View larger version (20K): [in a new window]   Figure 4 Length of hospital stay among 1,514,292 patients in NRMI 1, 2 and 3. The length of stay shortened among all patients and in those receiving IV thrombolytic therapy or primary PTCA. IV lytic = intravenous thrombolytic therapy.

View larger version (19K): [in a new window]   Figure 5 Hospital mortality among 1,514,292 patients in NRMI 1, 2 and 3. Hospital mortality declined among all patients and in those receiving IV thrombolytic therapy and primary PTCA. IV lytic = intravenous thrombolytic therapy.

View larger version (28K): [in a new window]   Figure 6 Medications prescribed at hospital discharge. The most notable upward trends were in medications shown to improve survival, such as aspirin, beta-blockers and ACE inhibitors. Ca blocker = calcium channel blocker.