A community-wide perspective into changing trends in the utilization of diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction

Abstract

Background-Limited data are available describing contemporary trends in the utilization of diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction (AMI). The objectives of our population-based investigation were to examine long-term trends (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) in the utilization of cardiac catheterization, percutaneous coronary interventions (PCI), and coronary artery bypass graft surgery (CABG) in a community sample of patients hospitalized with AMI. We examined the demographic and clinical characteristics of patients who received these diagnostic and interventional procedures and determined whether the profile of patients undergoing these procedures had changed over time.

Multidecade-long trends (1986–2005) in the utilization of coronary reperfusion and revascularization treatment strategies in patients hospitalized with acute myocardial infarction: a community-wide perspective

“…Our results are in agreement with the findings from several prior studies and with our earlier publication [5,6,16]. In the National Registry of Myocardial Infarction, a decline in the use of thrombolytic therapy was observed in patients hospitalized with AMI at more than 1200 medical centers throughout the United States between 1990 and 1999 (34% to 21%); only minor increasesin the use of both PCI (7-10%) and CABG surgery (11-13%) were observed over this period [5].…”

“…These findings are consistent with the results of numerous prior studies, which have shown the importance of rapid clot dissolution in patients with ST segment elevation MI [5,9,10]. Men were more likely to receive all procedures of interest relative to women, a finding that has been noted in several prior investigations [8,21], including our own [16]. In the National Inpatient Sample database, women underwent coronary angioplasty and stent placement at essentially similar rates with men over the period 1995 through 2001 [8]; women, however, were approximately 20% less likely to undergo coronary bypass surgery than men.…”

“…Use of PCI has become the primary coronary reperfusion treatment approach of choice in this patient population, whereas the use of CABG surgery has remained relatively stable over time, being used significantly less often during recent study years as compared with PCI. The results of this study update and extend our recently published findings to include an additional study year as well as to include data on the use of thrombolytic therapy in our study population [16]. …”

“…The results of this study clearly demonstrate that PCI has become the predominant modality used for the management of patients hospitalized with AMI throughout Central Massachusetts and has probably made an important contribution to the improving hospital as well as long-term prognosis of this patient population during the past several decades [12-14,16]. Monitoring of these evolving treatment approaches remains of continued importance, particularly in the present era of quality-assurance initiatives and cost-containment efforts.…”

Trends in the use of echocardiography and left ventriculography to assess left ventricular ejection fraction in patients hospitalized with acute myocardial infarction

“…In a study of Medicare patients, the rate of cardiac catheterization increased from 22 to 37 (per 1000 beneficiaries) between 1993 and 2001 16. A prior analysis from the Worcester Heart Attack Study also demonstrated that the utilization of cardiac catheterization increased more than three fold between 1986 and 2003 18. These findings demonstrate the widespread increase in the use of cardiac invasive procedures, many of which are associated with an EF measurement by ventriculography.…”