From the Department of Medicine (H.V.B.), University of California, San
Francisco; Department of Medical Affairs (H.V.B., L.J.B., T.B.), Genentech
Inc, South San Francisco, Calif; University of Alabama Medical Center,
Birmingham (W.J.R., J.G.C.); ClinTrials Research (Y.Z.), Lexington, Ky;
Washington University School of Medicine (A.J.T.), St. Louis, Mo; and Henry
Ford Medical Center (W.D.W.), Detroit, Mich.
Correspondence to Dr Hal V. Barron, 460 Point San Bruno Blvd, South San Francisco, CA 94080-4990. E-mail barron{at}ep4.ucsf.edu
Background—There is clear evidence
that reperfusion therapy improves survival in selected patients with an
acute myocardial infarction. However, several studies have suggested
that many patients with an acute myocardial infarction do not receive
this therapy. Whether this underutilization occurs in patients
appropriate for such therapy remains unclear.
Methods and Results—We examined the use of reperfusion therapy in
patients with an acute myocardial infarction hospitalized at 1470
hospitals participating in the National Registry of Myocardial
Infarction 2. We identified 84 663 patients who were eligible for
reperfusion therapy as defined by diagnostic changes on the
initial 12-lead ECG, presentation to the hospital within 6
hours from symptom onset, and no contraindications to
thrombolytic therapy. Twenty-four percent of these
eligible patients did not receive any form of reperfusion therapy
(7.5% of all patients). When multivariate
analyses were used, left bundle-branch block (odds ratio
[OR]=0.22; 95% CI=0.20 to 0.24), lack of chest pain at
presentation (OR=0.22; 95% CI=0.21 to 0.24), age >75
years (OR=0.40, 95% CI=0.36 to 0.43), female sex (OR=0.88, 95%
CI=0.83 to 0.92), and various preexisting
cardiovascular conditions were independent predictors
that the patient would not receive reperfusion therapy.
Conclusions—Reperfusion therapy may be underutilized in the
United States. Increased use of reperfusion therapy could potentially
reduce the unnecessarily high mortality rates observed in women, the
elderly, and other patient groups with the highest risk of death from
an acute myocardial infarction.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Use of Reperfusion Therapy for Acute Myocardial Infarction in the United States
Data From the National Registry of Myocardial Infarction 2
Key Words: myocardial infarction • reperfusion • thrombolysis • angioplasty • prognosis
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