title: Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Medicine, University of California, San Francisco, USA. barron@ep4.ucsf.edu
authors.forename: H V
authors.initials: HV
authors.lastname: Barron
authors.forename: L J
authors.initials: LJ
authors.lastname: Bowlby
authors.forename: T
authors.initials: T
authors.lastname: Breen
authors.forename: W J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: J G
authors.initials: JG
authors.lastname: Canto
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.forename: A J
authors.initials: AJ
authors.lastname: Tiefenbrunn
authors.forename: W D
authors.initials: WD
authors.lastname: Weaver
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries
chemical_list: D005343:Fibrinolytic Agents