Over the past two decades, findings from randomised controlled trials have revolutionised the treatment of patients with acute coronary syndromes (ACS). Clinical practice guidelines have been drawn up nationally and internationally to integrate the vast wealth of trial findings into up-to-date, clinically relevant treatment strategies.^1–4 So can patients who present to their local hospital with an ACS be assured that the treatment they receive is appropriate, evidence based, and in accordance with current guidelines? Studies worldwide have found that they cannot,^5,6 and that few doctors perform consistently as well as they should. Many of us do not practise what we preach.

Findings from registries and large randomised clinical trials show that many patients with ACS do not receive evidence based treatments, and that treatment standards vary significantly within and between countries.^5,6 It is therefore remarkable to read the report from the Myocardial Infarction National Audit Project (MINAP),⁷ published in this issue of Heart, which reveals that patients hospitalised with ACS in England or Wales actually have very high usage rates of evidence based treatments.

MINAP DATABASE

The MINAP database was developed to meet the audit requirements of the UK National Service Framework (NSF) for coronary heart disease, which was published in March 2000.⁴ The database started enrolling patients in October 2000 and now includes all hospitals in England, and all but one hospital in Wales, that manage patients with ACS. To date, 195 095 patients presenting for treatment with suspected ACS have been enrolled in the database, of which 156 902 had electrocardiographic or biochemical marker evidence of ACS. Of these, 53 208 patients were diagnosed with ST elevation ACS on the …