Changing trends in the managment of acute myocardial infarction: a five-year study

ABSTRACT

Over the past two decades, there has been considerable progress in the treatment of acute myocardial infarction [AMI] that led to substantially lower mortality and morbidity. Therefore, we carried out this study to evaluate the changes in our practice as related to AMI treatment over a five year period. This is a retrospective analysis that included all patients with a diagnosis of AMI, admitted to the coronary care unit between the first of January 1998 and the end of December 2002. The total number of patients with AMI was 2,280. Comparing the first year to the last year of the study, the use of medications at discharge increased significantly for beta-blockers [76 vs 88, p < 0.0001]; for angiotensin converting enzyme inhibitors [ACEI] [40 vs 45%, p = 0.02] and for lipid lowering drugs [25 vs 66%, p < 0.0001]. Similarly, the use of thrombolytic dru g s increased significantly [60 vs 66%, p < 0.001]. The time to administration of thrombolytic treatment shortened significantly [104 vs 70 minutes, p < 0.001]. The use of inhospital cardiac catheterization increased as well [7 vs 14%; p = 0.006]. Our study showed significant changes in the practice of AMI treatment over the five year study period. The use of therapies with proven benefit such as beta- blockers, ACEI, lipid lowering drugs, thrombolysis and in-hospital cardiac catheterization has increased. Although the time to thrombolytic treatment did shorten, it needs to be shortened further to obtain the maximum benefit from such therapy