Multidecade-long trends (1986-2005) in the utilization of coronary reperfusion and revascularization treatment strategies in patients hospitalized with acute myocardial infarction: a community-wide perspective.
OBJECTIVE
The objectives of our community-wide investigation were to describe multidecade-long trends (1986-2005) in the utilization of thrombolytic therapy, percutaneous coronary interventions, and coronary artery bypass graft surgery in patients hospitalized with acute myocardial infarction (AMI).


METHODS
The study sample consisted of 9422 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 11 annual periods between 1986 and 2005.


RESULTS
Increases in the utilization of percutaneous coronary interventions were observed between 1986 (2.0%) and 2005 (50.7%) with the most rapid increases beginning in the late 1990s. Utilization of coronary artery bypass graft surgery during hospitalization for AMI increased moderately in the 1990s, remained stable thereafter, and declined to being performed in 3.8% of hospitalized patients in 2005. The use of thrombolytic therapy increased between 1986 and 1995 (9.3-25.2%) and decreased markedly thereafter through 2005 (<1%). Demographic and clinical characteristics of several patients were associated with the receipt of these treatment regimens.


CONCLUSIONS
The results of this study in residents of a large Central New England community suggest an increasingly invasive approach to the management of patients hospitalized with AMI.
Wasser
Jared
J
Department of Community Health, Brown University, Providence, Rhode Island, USA.
Goldberg
Robert J
RJ
Spencer
Frederick A
FA
Yarzebski
Jorge
J
Gore
Joel M
JM
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data* / Q000639:trends; D003153:Community Health Services / Q000706:statistics & numerical data* / Q000639:trends; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data* / Q000639:trends; D003695:Delivery of Health Care / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends; D017678:Sex Distribution; D012737:Sex Factors; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors