title: Long-term trends in the use of coronary reperfusion strategies in acute myocardial infarction: a community-wide perspective.
abstract: BACKGROUND
  The objectives of our study were to examine long-term (1986-2003) trends in the use of percutaneous coronary interventions (PCI) and thrombolytic therapy in the management of patients hospitalized with acute myocardial infarction (AMI) while our secondary study goal was to examine factors associated with use of these coronary reperfusion strategies. While there have been considerable changes in the management of patients hospitalized with AMI over time, limited contemporary data are available about changing trends in the use of different coronary reperfusion strategies, particularly from the more generalizable perspective of a population-based investigation.
  
  
  METHODS
  The study sample consisted of 9,422 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003.
  
  
  RESULTS
  Divergent trends in the use of PCI and thrombolytic therapy during hospitalization for AMI were noted. Use of thrombolytic therapy increased after its introduction to clinical practice in the mid-1980's through the early 1990's with a progressive decline in use thereafter. In 2003, 3.5% of patients hospitalized with AMI were treated with clot lysing therapy. On the other hand, marked increases in the use of PCI during hospitalization for AMI were noted over time. In 2003, 42.1% of patients with AMI received a PCI. Several demographic and clinical factors were associated with the use of these different treatment strategies.
  
  
  CONCLUSIONS
  The results of our study in a large Northeast community suggest evolving changes in the hospital management of patients with AMI. Current management practices emphasize the utilization of PCI to restore coronary reperfusion to the infarct related artery.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. goldberr@ummhc.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Joseph
authors.initials: J
authors.lastname: Okolo
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000639:trends*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000639:trends