Clinical Studies
Use of angiotensin-converting enzyme inhibitors at discharge in patients with acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2

https://doi.org/10.1016/S0735-1097(98)00225-3Get rights and content
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Abstract

Objectives: This study was undertaken to examine recent trends in the use of angiotensin-converting enzyme (ACE) inhibitor therapy in patients discharged after acute myocardial infarction (AMI) and to identify clinical factors associated with ACE inhibitor prescribing patterns.

Background: Clinical trials have demonstrated a significant mortality benefit in patients treated with ACE inhibitors after AMI. Numerous studies have demonstrated underuse of other beneficial treatments for patients with AMI, such as beta-adrenergic blocking agents, aspirin and immediate reperfusion therapy.

Methods: Demographic, procedural and discharge medication data from 190,015 patients with AMI were collected at 1,470 U.S. hospitals participating in the National Registry of Myocardial Infarction 2.

Results: Prescriptions for ACE inhibitor therapy at hospital discharge increased from 25.0% in 1994 to 30.7% in 1996. Patients with a left ventricular ejection fraction ≤40% or evidence of congestive heart failure while in the hospital were discharged with ACE inhibitor treatment 42.6% of the time. Of patients experiencing an anterior wall myocardial infarction and no evidence of heart failure, 26.1% of patients were discharged with this treatment. Of the remaining patients, 15.6% received ACE inhibitors at discharge. ACE inhibitors were prescribed more often to elderly and diabetic patients as well as those requiring intraaortic balloon pump placement. This therapy was given less often to patients who underwent revascularization with coronary angioplasty or coronary artery bypass graft surgery or were treated with calcium channel blocking agents.

Conclusions: Physicians are prescribing ACE inhibitors in patients with myocardial infarction with increasing frequency. Those patients with the greatest expected benefit receive ACE inhibitor treatment most often. However, the majority of even these high risk patients were not discharged with this life-saving therapy.

Abbreviations

ACC
American College of Cardiology
ACE
angiotensin-converting enzyme
AHA
American Heart Association
AMI
acute myocardial infarction
CABG
coronary artery bypass graft surgery
CCP
Cooperative Cardiovascular Project
ECG
electrocardiographic
LVEF
left ventricular ejection fraction
NRMI 2
National Registry of Myocardial Infarction 2
PTCA
percutaneous transluminal coronary angioplasty

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This study was supported by Genentech, Inc.

§

A complete list of the participating registry hospitals is available from ClinTrials, Inc., Lexington, Kentucky 40504.