Ten-year trends in the incidence, treatment, and outcome of Q-wave myocardial infarction

The benefits of coronary reperfusion and antiplatelet therapy for patients with Q-wave acute myocardial infarction (Q-AMI) ore well established in the context of randomized, controlled trials. The use and recent impact of the se and other therapies on the broader, communitywide population of patients with Q-AMI is less well established. Residents of the Worcester, Massachus etts, metropolitan area (1990 census population 437,000) hospitalized with confirmed Q-AMI in all metropolitan Worcester, Massachusetts, hospitals in 4 1-year periods between 1986 and 1997 comprised the sample of interest. We examined the rates of occurrence, use of reperfusion strategies, and hospi tal mortality in a cohort of 711 patients with Q-AMI treated early in the r eperfusion era (1986 and 1988) in comparison to 669 patients with Q-AMI tre ated a decode later (1995 and 1997). The percentage of Q-AMI among all hosp italized patients with AMI decreased over the decade of reperfusion therapy : 52% in 1986 and 1988 versus 35% in 1995 and 1997 (p < 0.001). Use of repe rfusion therapy for patients with Q-AMI increased from 22% to 57%, with a m arked increase in the use of primary angioplasty over time (1% vs 16%). The profile of patients receiving reperfusion therapy also changed significant ly over the study period. Marked increases in use of antiplatelet therapy, p blockers, angiotensin-converting enzyme inhibitors, and decreased use of calcium channel blockers, were observed over time. The crude in-hospital ca se fatality rate declined from 19% (1986 and 1988) to 14% (1995 and 1997) i n patients with Q-AMI. Results of a multivariable regression analysis showe d lack of reperfusion therapy, older age, anterior wall AMI, and cardiogeni c shock to be independent predictors of in-hospital mortality in patients w ith Q-AMI. Thus, the percentage of all AMI's presenting as Q-AMI, and hospi tal mortality after Q-AMI, has decreased significantly in the past 10 years . The decrease in mortality occurs in the setting of broader use of reperfu sion and adjunctive therapy (including primary angioplasty). (C) 2000 by Ex cerpta Medica, Inc.