Does adherence to guideline-based medical therapy differ between patients presenting with STEMI versus NSTEMI?
Despite guidelines recommending similar medical therapy for both conditions, adherence to guideline-directed medical therapy remains significantly higher for STEMI patients compared to NSTEMI patients.
BACKGROUND: Clinical guidelines recommend similar medical therapy for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation MI (NSTEMI). METHODS AND RESULTS: Using the Get with the Guidelines-Coronary Artery Disease registry (GWTG-CAD), we analyzed data including 72 352 patients (48 966, NSTEMI; 23 386, STEMI) from 237 US sites between May 1, 2006 and March 21, 2010. Performance and quality measures were compared between NSTEMI and STEMI patients. NSTEMI patients were older and had a higher rate of medical comorbidities compared with STEMI patients, including prior coronary artery disease (38.5% versus 24.7%; P100 mg/dL 96.8% versus 91.0% (AOR, 1.85; 95% CI, 1.61-2.13). STEMI patients were also more likely to receive β-blockers within 24 hours of hospital arrival 93.9% versus 90.8% (AOR, 1.57; 95% CI, 1.37-1.79) and the following discharge medications: angiotensin-converting enzyme inhibitors or angiotensin receptor blocking agents 85.3% versus 77.4% (AOR, 1.62; 95% CI, 1.51-1.75), clopidogrel 85.6% versus 67.0% (AOR, 2.42; 95% CI, 2.23-2.61) or lipid-lowering medications 94.8% versus 88.0% (AOR, 1.71; 95% CI, 1.56-1.86). CONCLUSIONS: Among hospitals participating in GWTG-CAD, adherence with guideline-based medical therapy was high for patients with both STEMI and NSTEMI. Yet, there is still room for further improvement, particularly in the care of NSTEMI patients.
Somma et al. (2012) studied this question.