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Researchers tracking trends in the treatment of acute coronary syndrome report substantial improvements since 1999, with matching gains in survival for some patients. Between 1999 and 2005, prescription of most recommended drug treatments, including β blockers, statins, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs), increased. Use of percutaneous coronary intervention went up significantly in patients with or without ST segment elevation on their presenting electrocardiogram (from 32% to 64% and from 17% to 35%). Use of fibrinolytic reperfusion fell from 50% to 28% of patients with myocardial infarctioninfarction.
Rates of cardiogenic shock, heart failure, and death in hospital fell significantly during the same time period. Gains in survival over six months were more modest (mortality fell from 4.9% to 3.3%) and were confined to patients without ST segment elevation.
These data came from an established cohort of 44372 patients from 14 different countries. They suggest that doctors are getting better at following authoritative guidelines, and their patients are reaping the benefits. There's plenty of room for improvement, however. The researchers found no change in the proportion of patients with heart attack who failed to get reperfusion—29% (216/754) during the second six months of 2005.