Globally, reperfusion therapy underused after myocardial infarction

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Nearly a third of patients who are eligible for reperfusion therapy following ST-segment-elevation myocardial infarction do no receive treatment, according to a report published in the February 2nd issue of The Lancet.

Dr. Kim A. Eagle, from the University of Michigan at Ann Arbor, and colleagues evaluated the use of reperfusion therapy based on data from the 14-country Global Registry of Acute Coronary Events (GRACE). Of the nearly 10,000 patients enrolled, 1763 patients presented within 12 hours of symptom onset with ST-segment-elevation myocardial infarction.

The researchers found that 30% of these eligible patients did not receive fibrinolytic agents or undergo a percutaneous coronary intervention. Age of 75 years or older, no chest pain on presentation, and a history of diabetes, congestive heart failure, myocardial infarction, or coronary bypass surgery were all risk factors for not receiving reperfusion therapy.

The type of reperfusion therapy most often employed varied by country. The US had the highest rate of primary percutaneous coronary intervention, while Australia, New Zealand, and Canada had the lowest rates. Just the opposite pattern was seen for lytic drug use, the authors note.

"We weren't surprised to find that cardiologists were reticent to provide reperfusion therapy to very old patients," Dr. Eagle told Reuters Health. "Part of that reflects the fact that many clinical trials to date have excluded such patients from enrollment," he explained.

"This paper will hopefully be helpful in highlighting atypical groups of patients in whom reperfusion therapy could be beneficial," Dr. Eagle said. "Therapy should not be withheld simply because the patient did not have the classic presentation," he added. "We need to get away from the mindset that no chest pain means no myocardial infarction."

Lancet 2002;359:373-377.

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