Age and the utilization of cardiac catheterization following uncomplicatedfirst acute myocardial infarction treated with thrombolytic therapy (The second national registry of myocardial infarction [NRMI-2])

Considerable data indicates that patients < 50 years of age have lower morb idity and mortality after acute myocardial infarction (AMI) than older pati ents. It has been demonstrated that use of routine cardiac catheterization and revascularization in younger patients with AMI and successful thromboly sis does not confer benefit compared with a more conservative approach. Des pite this, it has been our impression that cardiac catheterization is frequ ently employed in younger patients with AMI, Patients with uncomplicated in itial AMI treated with thrombolytic therapy in the Second National Registry of Myocardial Infarction (NRMI-2) between June 1994 and April 1998 were id entified. Patients were categorized into 4 age strata for purposes of analy sis. A total of 61,232 cases met our inclusion criteria. Cardiac catheteriz ation was performed during hospitalization in 78% of patients after an unco mplicated initial AMI, Age was inversely associated with receipt of cardiac catheterization: 85% of those less than or equal to 49 years old underwent catheterization compared with 63% of those greater than or equal to 70 yea rs old. Regression analysis revealed that use of catheterization was 2.9 ti mes greater (95% confidence intervals 2.7 to 3.2) in patients less than or equal to 49 years old compared with those greater than or equal to 70 years old. Geographic location and payor status also strongly influenced utiliza tion of this procedure. In conclusion, routine coronary angiography after u ncomplicated AMI is extensively utilized in all age groups, particularly in those < 50 years of age. The efficacy and cost effectiveness of this strat egy in these patients has not yet been determined in clinical trials. (C) 2 001 by Excerpta Medico, Inc.