USE OF REPERFUSION THERAPY FOR ACUTE MYOCARDIAL-INFARCTION IN THE UNITED-STATES - DATA FROM THE NATIONAL REGISTRY OF MYOCARDIAL-INFARCTION 2

Background - There is clear evidence that reperfusion therapy improves survival in selected patients with an acute myocardial infarction. Ho wever, several studies have suggested that many patients with an acute myocardial infarction do not receive this therapy. Whether this under utilization occurs in patients appropriate for such therapy remains un clear. Methods and Results - We examined the use of reperfusion therap y in patients with an acute myocardial infarction hospitalized at 1470 hospitals participating in the National Registry of Myocardial Infarc tion 2, We identified 84663 patients who were eligible for reperfusion therapy as defined by diagnostic changes on the initial 12-lead EGG, presentation to the hospital within 6 hours from symptom onset, and no contraindications to thrombolytic therapy, Twenty-four percent of the se eligible patients did not receive any form of reperfusion therapy ( 7.5% of all patients), When multivariate analyses were used, left bund le-branch block (odds ratio [OR] = 0.22; 95% CI = 0.20 to 0.24), lack of chest pain at presentation (OR = 0.22; 95% CI = 0.21 to 0.24), age > 75 years (OR = 0.40, 95% CI = 0.36 to 0.43), female sex (OR = 0.88, 95% CI = 0.83 to 0.92), and various preexisting cardiovascular conditi ons were independent predictors that the patient would not receive rep erfusion therapy. Conclusions - Reperfusion therapy may be underutiliz ed in the United States. Increased use of reperfusion therapy could po tentially reduce the unnecessarily high mortality rates observed in wo men, the elderly, and other patient groups with the highest risk of de ath from an acute myocardial infarction.