title: A decade of improvement in the management of New Zealand ST-elevation myocardial infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome (ACS) Audit Group national audits of 2002, 2007 and 2012.
abstract: OBJECTIVE
  To audit the management of ST-segment elevation myocardial infarction (STEMI) patients admitted to a New Zealand Hospital over three 14-day periods to review their number, characteristics, management and outcome changes over a decade.
  
  
  METHODS
  The acute coronary syndrome (ACS) audits were conducted over 14 days in May of 2002, 2007 and 2012 at New Zealand Hospitals admitting patients with a suspected or definite ACS. Longitudinal analyses of the STEMI subgroup are reported.
  
  
  RESULTS
  From 2002 to 2012, the largest change in management was the proportion of patients undergoing reperfusion by primary PCI from 3% to 15% and 41%; P<0.001, and the rates of second antiplatelet agent use in addition to aspirin from 14% to 62% and 98%; P<0.001. The use of proven secondary prevention medications at discharge also increased during the decade. There were also significant increases in cardiac investigations for patients, especially echocardiograms (35%, 62% and 70%, P<0.001) and invasive coronary angiograms (31%, 58% and 87%, P<0.001). Notably even in 2012, one in four patients presenting with STEMI did not receive any reperfusion therapy.
  
  
  CONCLUSIONS
  Substantial improvements have been seen in the management of STEMI patients in New Zealand over the last decade, in accordance with evidenced-based guideline recommendations. However, there appears to be considerable room to optimise management, particularly with the use of timely reperfusion therapy for more patients.
authors.affiliation: Cardiologist, Christchurch Hospital, Christchurch.
authors.forename: John M
authors.initials: JM
authors.lastname: Elliott
authors.affiliation: Cardiology Registrar, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland.
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.affiliation: Statistician, University of Auckland, Auckland.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Cardiologist, Dunedin Hospital, Dunedin.
authors.forename: Michael Ja
authors.initials: MJ
authors.lastname: Williams
authors.affiliation: Cardiologist, Wellington Hospital, Wellington.
authors.forename: Philip
authors.initials: P
authors.lastname: Matsis
authors.affiliation: Cardiologist, Christchurch Hospital, Christchurch.
authors.forename: Richard
authors.initials: R
authors.lastname: Troughton
authors.affiliation: Cardiologist, Nelson Hospital, Nelson.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hamer
authors.affiliation: Cardiologist, Waikato Hospital, Hamilton.
authors.forename: Gerry
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Cardiologist, Wellington Hospital, Wellington.
authors.forename: Stewart
authors.initials: S
authors.lastname: Mann
authors.affiliation: Cardiologist, Christchurch Hospital, Christchurch.
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.affiliation: Cardiologist, Liverpool Hospital, SW Sydney Clinical School (UNSW) Sydney, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland. For the NZ Regional Cardiac Society ACS Audit Group.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Ellis
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography / Q000706:statistics & numerical data / Q000639:trends; D004359:Drug Therapy, Combination / Q000639:trends; D004453:Echoencephalography / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data* / Q000639:trends; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000639:trends*; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000628:therapy*; D055502:Secondary Prevention / Q000639:trends; D061665:Time-to-Treatment
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin