Prepared by: ACTION Registry-GWTG Results: January – December, 2008.

Prepared by:

ACTION Registry-GWTG Results:January – December, 2008

Current Site Distribution

Last updated: 12/31/08

AK(1)

WA(11)

OR(9)

CA(20)

ID(1)

NV(1)

MT(2)

WY(0)

CO(7)

NM(1)

ND(1)

SD(1)

NE (4)

KS(8)

OK(4)

TX(26)

MN(5)

IA(6)

MO(12)

AR(1)

LA(2)

WI(11) MI

(12)

MI

UT(0)

AZ(2)

HI (0)

IL(23)

IN(14)

KY(2)

TN(10)

MS(3)

AL(1)

GA(10)

FL(17)

SC(4)

NC(23)

VA(9)

OH(22)

WV(1)

PA(23)

NY(11)

MD (10)

ME(2)

VT (0)

NH (1)

NJ (4)

MA (3)

CT (3)

DE (0)

RI (0)

DC (0)

Active Sites = 365

Baseline Characteristics - STEMI

ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008

Variable STEMI

(n = 20,998) Mean age ± SD (yrs) 62 ± 14 Female sex 30% Diabetes mellitus 23% Prior MI 20% Prior CHF 5% Prior PCI 20% Prior CABG 7%

Hospital Presentation Characteristics - STEMI

Variable STEMI

(n = 20,998) Qualifying Criteria Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% Hypotension 6% Signs of CHF 12%


In-Hospital Outcomes - STEMI

Variable STEMI

(n=20,998) Death* 5.8% Re-infarction 1.1% CHF 6.8% Cardiogenic Shock 6.2% Stroke 0.8% RBC Transfusion# 6.4%

* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patientsACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008

Use of Reperfusion Therapy for STEMI

STEMISTEMIN = 20,998N = 20,998

ReperfusionReperfusionN = 16,374 (78%)N = 16,374 (78%)

No Reperfusion –No Reperfusion –No Contraindication ListedNo Contraindication Listed

N = 1163 (6%)N = 1163 (6%)

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

N= 3,011 (14%)N= 3,011 (14%)

Primary PCI – 86%*Primary PCI – 86%*Fibrinolytics – 13%*Fibrinolytics – 13%*

Both PCI + Lytics – 1%*Both PCI + Lytics – 1%*

* Among patients receiving reperfusion


81%

18%

57%

0%

20%

40%

60%

80%

100%

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

STEMI – Door to Balloon and Door to Needle Times:

Cumulative 12 Month Data


76%80%

84% 87%

0%

20%

40%

60%

80%

100%

Q1 08 Q2 08 Q3 08 Q4 08

STEMI Primary PCI Results -Non-Transfer Patients with DTB 90

mins

73% of the primary PCI patients are not transferred in

14%17%

20% 21%

40%44%

49%

54%

0%

10%

20%

30%

40%

50%

60%

Q1 08 Q2 08 Q3 08 Q4 08

STEMI Primary PCI Results - DTB Benchmarks for Transfer-In Patients

1st Door to Balloon < 90 Minutes

1st Door to Balloon < 120 Minutes

27% of the primary PCI patients are transferred in

STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

102

130

182

53

70

88

Q1 08

97

123

165

52

67

84

Q2 08

96

120

157

51

66

Q3 08

94

117

150

50

64

79

Q4 08

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

82

403020

250

100

STEMI Acute (< 24 hrs) Medications 98%

95% 95%

73%

88%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UFH)

GP llb-lllaInhibitors

Clopidogrel


STEMI Discharge Medications

99% 97%

88%93% 92%

0%

20%

40%

60%

80%

100%

ASA Beta Blocker ACE-I or ARB Statins Clopidogrel

% U

se%

Use


STEMI Discharge Interventions

91%95%

82%

97%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

CardiacRehab

Referral

SmokingCessation


Variable NSTEMI

(n = 31,774) Mean age ± SD (yrs) 67 ± 14 Female sex 39% Diabetes mellitus 34% Prior MI 28% Prior CHF 16% Prior PCI 24% Prior CABG 19%


Baseline Characteristics - NSTEMI

Hospital Presentation Characteristics -NSTEMI

Variable NSTEMI

(n = 31,774) Qualifying Criteria ST-segment depression 25% Transient ST-segment elevation 3% Presenting Characteristics Tachycardia 22% Hypotension 3% Signs of CHF 21%


In-Hospital Outcomes - NSTEMI

* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patients

Variable NSTEMI

(n=32,377) Death* 4.1% Re-infarction 1.0% CHF 7.5% Cardiogenic Shock 2.7% Stroke 0.7% RBC Transfusion# 8.9%


NSTEMI Acute (< 24 hrs) Medications 97%

92% 92%

47%

60%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UFH)


Clopidogrel


NSTEMI Acute Medication Overdosing Trends

* Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg)

# Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended)


26% 26% 26% 25%

15% 15% 15% 15%

9% 10% 10% 9%

0%

5%

10%

15%

20%

25%

30%

Q1 2008 Q2 2008 Q3 2008 Q4 2008

UFH *LMWH #GP llb-llla

75%

62%

46%39%

11%

0%

20%

40%

60%

80%

100%

Cath Cath < 48 hr PCI PCI < 48 hr CABG

NSTEMI Invasive Cardiac Procedures


NSTEMI Revascularization Strategy Trends


45% 46% 46%

44% 42% 42%42%

45%

11%11%12%11%

0%

10%

20%

30%

40%

50%

60%

Q1 2008 Q2 2008 Q3 2008 Q4 2008

Medically Managed PCI CABG

NSTEMI Discharge Medications

97% 95%

74%

92%

74%

0%

20%

40%

60%

80%

100%

ASA Beta Blocker ACE-I or ARB Lipid LoweringAgent

Clopidogrel


NSTEMI Discharge Clopidogrel Use byRevascularization Strategies

55%

97%

28%

0%

20%

40%

60%

80%

100%

MedicallyManaged

PCI CABG


NSTEMI Discharge Interventions

84%91%

72%

95%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

CardiacRehab

Referral

SmokingCessation


Variable STEMI

(n=20,998) NSTEMI

(n=31,774) Mean age + SD (yrs) 62 + 14 67 + 14 Female sex 30% 39% Diabetes mellitus 23% 34% Prior MI 20% 28% Prior CHF 5% 16% Prior PCI 20% 24% Prior CABG 7% 19%


Baseline Characteristics –STEMI vs. NSTEMI

Hospital Presentation Characteristics - STEMI vs. NSTEMI

Variable STEMI

(n=20,998) NSTEMI

(n=31,774) Qualifying Criteria ST-Segment Depression 25% Transient ST-Segment Elevation 4% Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% 22% Hypotension 6% 3% Signs of CHF 14% 22%


In-Hospital Outcomes - STEMI vs. NSTEMI

Variable STEMI

(n=20,998) NSTEMI

(n=31,774) Death* 5.8% 4.1% Re-infarction 1.1% 1.0% CHF 6.8% 7.5% Cardiogenic Shock 6.2% 2.7% Stroke 0.8% 0.7% RBC Transfusion# 6.4% 8.9%

* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patientsACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008

Non-CABG Major Bleeding and Transfusion –STEMI vs. NSTEMI

13%12%

15%

10%

0%

5%

10%

15%

20%

Major Bleed Any RBC Transfusion

STEMI NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008

Acute Medications - STEMI vs NSTEMI 98%

95% 95%

73%

88%

97%92% 92%

47%

60%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UFH)


Clopidogrel


Discharge Medications - STEMI vs NSTEMI 99% 97%

88%93% 92%

97% 95%

74%

87%

74%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers ACE-I or ARB Statins Clopidogrel


Discharge Interventions – STEMI vs. NSTEMI

91%95%

82%

97%

84%91%

72%

95%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

Cardiac RehabReferral

SmokingCessation

STEMI NSTEMIACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008

Prepared by: ACTION Registry-GWTG Results: January – December, 2008.

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Transcript of Prepared by: ACTION Registry-GWTG Results: January – December, 2008.