Document Type

Article

Journal or Conference Title

The American Journal of Medicine

ISSN

002-9343

Volume

120

Issue

8

First Page

6.93E+01

Last Page

6.93E+01

Publication Date

8-2007

Department

Occupational Therapy

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<0.001). Utilization remained significantly lower in key subgroups in the most recent time period: those without chest pain (OR, 0.29; 95% 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.

Publisher Statement

Originally published as Nallamothu, B. K., Blaney, M. E., Morris, S. M., Parsons, L., Miller, D. P., Canto, J. G., ... & National Registry of Myocardial Infarction Investigators. (2007). Acute reperfusion therapy in ST-elevation myocardial infarction from 1994-2003. The American Journal of Medicine, 120(8), 693-e1.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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