title: Use of the invasive management strategy for patients with non-Q-wave myocardial infarction: an observational database report from the Worcester Heart Attack Study.
abstract: BACKGROUND
  Recent randomized clinical trials have suggested a benefit of an invasive management strategy in patients with acute coronary syndromes. However, the broader use and impact of the invasive management approach has not been established for patients with acute coronary syndromes beyond the relatively narrow patient populations studied in randomized, clinical trials.
  
  
  METHODS
  Residents of the Worcester, Mass, area who were hospitalized with non-Q-wave acute myocardial infarction (AMI) at all area hospitals in 5 annual periods between 1990 and 1997 comprised the sample of interest (n = 2436). We examined the extent of use of an invasive versus a conservative strategy for hospital management, occurrence of clinical complications, and hospital mortality in patients with non-Q-wave AMI.
  
  
  RESULTS
  An invasive approach to hospital management was used in only 30% of patients with non-Q-wave AMI, although there was an increase over time in the use of an invasive treatment strategy (18% in 1990 vs 33% in 1997). Factors associated with use of the invasive strategy were younger age, male sex, development of cardiogenic shock, as well as adjunctive medical treatment. Overall hospital mortality was high at 12%. Use of the invasive approach, aspirin, nitrates and beta-blockers were associated in logistic regression modeling with significant improvements in survival.
  
  
  CONCLUSIONS
  An invasive approach to hospital management of non-Q-wave AMI was used infrequently in this population-based cohort during the 1990s.
authors.affiliation: Cardiac Unit, University of Vermont College of Medicine, Burlington, Vt 05401, USA. harold.dauerman@vtmednet.org
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data / Q000639:trends; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D012737:Sex Factors; D013577:Syndrome