Title: Treatments, Trends, and Outcomes of Acute Myocardial Infarction and Percutaneous Coronary Intervention
Date Posted: July 12, 2010
Authors: Roe MT, Messenger JC, Weintraub WS, et al.
Citation: J Am Coll Cardiol 2010;56:254-263.
Perspective:
The following are 10 points to remember about this report from the National Cardiovascular Data Registry (NCDR).
1. Given the attendant risks of mortality and morbidity, acute myocardial infarction (AMI) remains a principal focus of cardiovascular therapeutics.
2. Percutaneous coronary intervention (PCI) remains a central therapy for patients with symptomatic coronary artery disease, particularly among patients with AMI.
3. The NCDR AR-G registry is a national, voluntary quality improvement registry program that is a partnership of the American College of Cardiology and American Heart Association, and includes data on the in-hospital treatment of patients with AMI, both ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).
4. The goal of this report was to evaluate contemporary clinical practice, as well as recent trends in treatments and outcomes, among AMI and PCI patients.
5. There were significant increases in the timeliness of AMI patient presentation after symptom onset, in the proportion of eligible STEMI patients receiving reperfusion therapy, and in the timeliness of reperfusion therapy for STEMI.
6. The use of early cardiac catheterization within 48 hours and the use of revascularization procedures increased in NSTEMI patients in the study cohort.
7. Furthermore, significant reductions in the rate of overdosing of antithrombotic agents were demonstrated among NSTEMI patients—a finding that highlights a new area of focus in the AMI performance measures.
8. Among patients in the registry, risk-adjusted in-hospital mortality rates decreased from 6.2% to 5.5% among STEMI patients, and decreased from 4.3% to 3.9% among NSTEMI patients during the study period.
9. There were declining rates of drug-eluting stent (DES) utilization in patients undergoing PCI for both acute coronary syndrome (ACS) and non-ACS from 2005 to 2009, but there has been a recent widespread incorporation of new DES technologies among patients receiving a DES in the CathPCI registry.
10. Overall, the report suggests that the contemporary profile of care patterns for patients with AMI and those undergoing PCI has changed over a relatively short time, while significant improvements in the receipt and timeliness of reperfusion therapy for STEMI, in the overdosing of antithrombotic therapies, in the safety and results of PCI procedures, and in composite measures of AMI care have occurred.
Author(s):
Debabrata Mukherjee, M.D., F.A.C.C.
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