Special Articles: NRMI 1990-2006Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006
Section snippets
Methods
NRMI is an industry-sponsored observational study whose methods have previously been described.13, 16
To be included in the registry, patients must have had an acute MI documented according to local hospital criteria, usually including a history suggestive of acute MI and corroborated by cardiac enzymes, 12-lead electrocardiogram (ECG), coronary angiography, or International Classification of Diseases, Ninth Revision, diagnostic code of MI. STEMI was defined as ST-segment elevation or left
Results
Since 1990, NRMI has enrolled 2,515,106 patients presenting with acute MI from 2,157 hospitals. Among the 1,374,232 (54.6%) patients with STEMI, 905,590 (65.9%) were eligible for reperfusion upon arrival to the hospital and 774,279 (56.3%) were eligible for time-to-reperfusion performance metrics. Among the reperfusion-eligible patients, fibrinolytic therapy was the most prevalent reperfusion modality in 1990, but its prevalence fell from 52.5% in 1990 to 27.6% in 2006 (Figure 1,A). The use of
Discussion
Early and complete revascularization after STEMI has been consistently associated with lower mortality in observational studies.1, 2, 3, 4 Current guidelines suggest that a realistic goal is to facilitate rapid recognition and treatment of patients with STEMI such that fibrinolytic therapy can be administered within 30 minutes of presentation and pPCI can be performed within 90 minutes.5, 6 Since its inception in 1990, NRMI has documented the association of improvement in time-to-reperfusion
Conclusion
Among more than 1.3 million STEMI patients enrolled in NRMI, D2N and D2B times have decreased significantly over the past several years. This has been associated with a significant decline in in-hospital mortality, and the contribution of improved D2N and D2B times to improvement in mortality was significant.
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This study was supported in part by Genentech (San Francisco, CA).