2007 ACTION Registry™ 2nd Quarter Results

Background

• Recent studies have demonstrated that guidelines adherence is sub-optimal for a large proportion of ACS patients.

• The ACTION Registry™ has been created from the previous CRUSADE and NRMI registries to enable hospitals to measure and improve their performance in treating patients with ACS

• Contained are performance information from the 2006-2007 harvest from both the CRUSADE and ACTION registries.

Current ACTION Site Distribution

Last updated: 1/4/07

AK(1)

WA(12)

OR(6)

CA(15)

ID(1)

NV(0)

MT(1)

WY(0)

CO(7)

NM(0)

ND(1)

SD(1)

NE (4)

KS(5)

OK(2)

TX(11)

MN(5)

IA(7)

MO(8)

AR(1)

LA(2)

WI(6) MI

(14)

MI

UT(0)

AZ(3)

HI (0)

IL(18)

IN(12)

KY(2)

TN(8)

MS(5)

AL(3)

GA(8)

FL(9)

SC(3)

NC(17)

VA(11)

OH(22)

WV(1)

PA(26)

NY(10)

MD (11)

ME(1)

VT (0)

NH (1)

NJ (6)

MA (1)

CT (2)

DE (0)

RI (0)

DC (0)

Active Sites = 290

ACTION 2007 Cumulative Data Submission

4169

7956

11960

16201

20355

24319

0

5000

10000

15000

20000

25000

Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07

Nu

mb

er o

f re

cord

s

Complexity of STEMI PatientsBaseline Characteristics

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

Variable STEMI

(n = 11,854) Mean age ± SD (yrs) 62 ± 12 Female sex 30% Diabetes mellitus 23% Prior MI 18% Prior CHF 5% Prior PCI 18% Prior CABG 7%

Hospital Presentation - STEMI

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

Variable STEMI

(n = 11,854) Qualifying Criteria Persistent ST Elevation 95% New LBBB 5% Presenting Characteristics Tachycardia 16% Hypotension 6% Signs of CHF 12%

In-Hospital Outcomes - STEMI

*Transfusion among non-CABG patientsACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007*Transfusion among non-CABG patientsACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

Variable STEMI

(n=11,854) Death 6.0% Re-infarction 1.2% CHF 6.6% Cardiogenic Shock 7.1% Stroke 0.8% RBC Transfusion 6.2%

Use of Reperfusion Therapy for STEMI

STEMISTEMIN = 11,854N = 11,854

ReperfusionReperfusionN = 8,954 (76%)N = 8,954 (76%)

No Reperfusion –No Reperfusion –No Contraindication ListedNo Contraindication Listed

N = 690 (6%)N = 690 (6%)

Not Eligible for Not Eligible for Reperfusion Therapy Reperfusion Therapy Contraindication Listed Contraindication Listed

N= 1,926 (16%)N= 1,926 (16%)

Primary PCI – 81%*Primary PCI – 81%*Fibrinolytics – 10%*Fibrinolytics – 10%*

Both PCI + Lytics – 9%*Both PCI + Lytics – 9%*

90% of eligible patients reperfused

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

* Among patients receiving reperfusion

60%

5%

40%

0%

20%

40%

60%

80%

DTB <= 90 min -Non-Transfer In

DTB <= 90 min -Transfer In

DTN <= 30 min - All

DTB = 1st Door to Balloon for Primary PCIDTN = Door to Needle for Lytics

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)

STEMI – Door to Balloon and Door to Needle Times:

Cumulative 12 Month Data

47% 50%

64% 64%

0%

20%

40%

60%

80%

100%

Q3 06 Q4 06 Q1 07 Q2 07

CRUSADE to ACTION Quarter Results -Non-Transfer Patients with DTB 90 mins

Non-transfer patients represent ~ 2/3 of primary PCI population

2%

6% 6% 5%

14%

21% 21% 21%

0%

10%

20%

30%

40%

Q3 06 Q4 06 Q1 07 Q2 07

CRUSADE to ACTION Quarter Results - DTB Benchmarks for Transfer-In Patients

Transfer In patients represent ~ 1/3 of primary PCI population

1st Door to Balloon < 90 Minutes

1st Door to Balloon < 120 Minutes

CRUSADE to ACTION Door-to-Balloon Times –

Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

130

176

231

67

90

119

Q3 06

122

148

211

67

87

119

Q4 06

123

170

236

6279

Q1 07

122

159

223

59

78

103

Q2 07

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

103

403020

250

100

STEMI Acute Medications

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)

98% 96%93%

75%

84%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UFH)

GP llb-lllaInhibitors

Clopidogrel

*Ideal patients ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n= 11,854)

STEMI Discharge Medications

99% 97%

89% 91% 90%

0%

20%

40%

60%

80%

100%

ASA B-Blocker ACE-I or ARB* Statins Clopidogrel

% U

se%

Use

STEMI Discharge Interventions

81%

92%

77%

96%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

CardiacRehab

Referral

SmokingCessation

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)