TY - JOUR
T1 - Guideline adherence after ST-segment elevation versus non-ST-segment elevation myocardial infarction
AU - Somma, Keith A.
AU - Bhatt, Deepak L.
AU - Fonarow, Gregg C.
AU - Cannon, Christopher P.
AU - Cox, Margueritte
AU - Laskey, Warren
AU - Frank Peacock, W.
AU - Hernandez, Adrian F.
AU - Peterson, Eric D.
AU - Schwamm, Lee
AU - Saxon, Leslie A.
PY - 2012/9
Y1 - 2012/9
N2 - Background: Clinical guidelines recommend similar medical therapy for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation MI (NSTEMI). Methods and Results: Using the Get with the Guidelines-Coronary Artery Disease registry (GWTG-CAD), we analyzed data including 72 352 patients (48 966, NSTEMI;23 386, STEMI) from 237 US sites between May 1, 2006 and March 21, 2010. Performance and quality measures were compared between NSTEMI and STEMI patients. NSTEMI patients were older and had a higher rate of medical comorbidities compared with STEMI patients, including prior coronary artery disease (38.5% versus 24.7%; P<0.0001), heart failure (17.5% versus 6.2%; P<0.0001), hypertension (70.8% versus 59.1%; P<0.0001) and diabetes mellitus (34.9 versus 23.3%; P<0.0001). Adjusting for confounding variables, STEMI patients were more likely to receive aspirin within 24 hours 98.5% versus 97.1% (adjusted odds ratio [AOR], 1.63;95% confdence interval [CI], 1.32-2.02), be discharged on aspirin 98.5% versus 97.3% (AOR, 1.33;95% CI, 1.19-1.49), β-blockers 98.2% versus 96.9% (AOR, 1.48;95% CI, 1.35-1.63), or lipid-lowering medication for low-density lipoprotein level >100 mg/dL 96.8% versus 91.0% (AOR, 1.85;95% CI, 1.61-2.13). STEMI patients were also more likely to receive β-blockers within 24 hours of hospital arrival 93.9% versus 90.8% (AOR, 1.57;95% CI, 1.37-1.79) and the following discharge medications: Angiotensin-converting enzyme inhibitors or angiotensin receptor blocking agents 85.3% versus 77.4% (AOR, 1.62;95% CI, 1.51-1.75), clopidogrel 85.6% versus 67.0% (AOR, 2.42;95% CI, 2.23-2.61) or lipid-lowering medications 94.8% versus 88.0% (AOR, 1.71;95% CI, 1.56-1.86). Conclusions: Among hospitals participating in GWTG-CAD, adherence with guideline-based medical therapy was high for patients with both STEMI and NSTEMI. Yet, there is still room for further improvement, particularly in the care of NSTEMI patients.
AB - Background: Clinical guidelines recommend similar medical therapy for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation MI (NSTEMI). Methods and Results: Using the Get with the Guidelines-Coronary Artery Disease registry (GWTG-CAD), we analyzed data including 72 352 patients (48 966, NSTEMI;23 386, STEMI) from 237 US sites between May 1, 2006 and March 21, 2010. Performance and quality measures were compared between NSTEMI and STEMI patients. NSTEMI patients were older and had a higher rate of medical comorbidities compared with STEMI patients, including prior coronary artery disease (38.5% versus 24.7%; P<0.0001), heart failure (17.5% versus 6.2%; P<0.0001), hypertension (70.8% versus 59.1%; P<0.0001) and diabetes mellitus (34.9 versus 23.3%; P<0.0001). Adjusting for confounding variables, STEMI patients were more likely to receive aspirin within 24 hours 98.5% versus 97.1% (adjusted odds ratio [AOR], 1.63;95% confdence interval [CI], 1.32-2.02), be discharged on aspirin 98.5% versus 97.3% (AOR, 1.33;95% CI, 1.19-1.49), β-blockers 98.2% versus 96.9% (AOR, 1.48;95% CI, 1.35-1.63), or lipid-lowering medication for low-density lipoprotein level >100 mg/dL 96.8% versus 91.0% (AOR, 1.85;95% CI, 1.61-2.13). STEMI patients were also more likely to receive β-blockers within 24 hours of hospital arrival 93.9% versus 90.8% (AOR, 1.57;95% CI, 1.37-1.79) and the following discharge medications: Angiotensin-converting enzyme inhibitors or angiotensin receptor blocking agents 85.3% versus 77.4% (AOR, 1.62;95% CI, 1.51-1.75), clopidogrel 85.6% versus 67.0% (AOR, 2.42;95% CI, 2.23-2.61) or lipid-lowering medications 94.8% versus 88.0% (AOR, 1.71;95% CI, 1.56-1.86). Conclusions: Among hospitals participating in GWTG-CAD, adherence with guideline-based medical therapy was high for patients with both STEMI and NSTEMI. Yet, there is still room for further improvement, particularly in the care of NSTEMI patients.
KW - Acute myocardial infarction
KW - Coronary Artery Disease
KW - Myocardial infarction
KW - Non-ST-segment elevation acute coronary syndromes
KW - ST-segment elevation myocardial infarction
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U2 - 10.1161/CIRCOUTCOMES.111.963959
DO - 10.1161/CIRCOUTCOMES.111.963959
M3 - Article
C2 - 22949493
AN - SCOPUS:84868642255
SN - 1941-7713
VL - 5
SP - 654
EP - 661
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 5
ER -