Treatments, Trends, and Outcomes of Acute Myocardial Infarction and Percutaneous Coronary Intervention

From Journal of the American College of Cardiology

Matthew T. Roe et al

Abstract and Introduction
Introduction
Coronary artery disease remains a major public health problem in the U.S. as many Americans experience an acute myocardial infarction (MI) and/or undergo percutaneous coronary intervention (PCI) each year. Given the attendant risks of mortality and morbidity, acute MI remains a principal focus of cardiovascular therapeutics. Moreover, 30-day mortality and rehospitalization rates for acute MI are publicly reported in an effort to promote optimal acute MI care, and aspects of MI care delivery are the focus of local, regional, and national quality initiatives.[1–3] PCI remains a central therapy for patients with symptomatic coronary artery disease, particularly among patients with acute MI, and has garnered tremendous attention in the last decade with issues such as the risks and benefits of drug-eluting stents (DES) and adjunctive antithrombotic therapies.

However, there are few representative data describing contemporary patterns of care and outcomes trends for patients with acute MI and/or those undergoing PCI. This is of particular importance because the process of updating clinical practice guidelines and quality metrics for acute MI and PCI has accelerated.[4] Updates or revisions to the American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines for PCI, ST-segment elevation myocardial infarction (STEMI), and unstable angina (UA)/non–ST-segment elevation myocardial infarction (NSTEMI) have been published within the last 3 years, building upon prior versions published earlier in the decade.[5–7] The ACC and AHA have also published performance measures to direct quality assessment and improvement activities.[8] However, data are lacking on current guideline adherence as well as on trends in the quality of care and outcomes for the large population of patients in the U.S. with symptomatic coronary artery disease.

Large-scale, national clinical registries provide an important opportunity to evaluate current clinical practice. The American College of Cardiology's National Cardiovascular Data Registry (NCDR) comprises a suite of programs involving >2,400 hospitals in the U.S. (www.ncdr.com). We analyzed the NCDR Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry–Get With The Guidelines (AR-G) and Catheterization PCI (CathPCI) databases to characterize recent trends in treatment and outcomes among patients with acute MI and those undergoing PCI. More specifically, we sought to evaluate patient and hospital characteristics, rates of guideline adherence, procedural details, and in-hospital outcomes related to acute MI and PCI care over the last several years.

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