TRENDS IN THE USE OF DRUG THERAPIES IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - 1988 TO 1992

Objectives. In this study, we investigated the use of thrombo lytic ag ents and other cardiac drugs in a national cohort of patients with acu te myocardial infarction and assessed the influence of large clinical studies on types of thrombolytic therapy prescribed. Background. Infor mation about usage patterns for these drugs is unavailable, and little is known about the impact of large clinical trials on their use. Meth ods. We conducted a retrospective cohort study of 65,011 patients who were treated for acute myocardial infarction during fiscal years 1988 to 1992 (October 1, 1987 to September 30, 1992) in hospitals participa ting in the SMS Corporation's on-line data pool. Results. The overall thrombolysis rate for patients with acute myocardial infarction increa sed from 11% in fiscal year 1988 to 18% in fiscal year 1990 and has re mained approximately at that level since then. In mid-1989, tissue pla sminogen activator was used in 90% of the patients receiving thromboly sis, whereas streptokinase was used in only 10%. Since 1991, tissue pl asminogen activator has been used in 60% of patients and streptokinase in almost 30%. Much of this change came after presentation and public ation of results of the Second Gruppo Italiano per lo Studio Della Sop ravvivenza nell'Infarto Miocardico (GISSI-2) and the Third Internation al Study of Infarct Survival (ISIS-3) trials. Over these 5 years, use of beta-adrenergic blocking agents increased steadily, and use of calc ium channel blocking agents declined steadily. Conclusions. Current us age rates of thrombolytic therapy are lower than expected, but trends in usage rates for beta-blockers and calcium channel blockers reflect their increasing and decreasing approval, respectively. Presentation a nd publication of results from the Third International Study of Infarc t Survival and the Second Gruppo Italiano per lo Studio Della Sopravvi venza nell'Infarto Miocardico trials appear to have influenced the typ e of thrombolytic agent prescribed.