Methods:

Patients presenting with STEMI and enrolled in the American Heart Association’s Get With the Guidelines Coronary Artery Disease registry were analyzed. The cohort was divided into those ages 45 years or less and those ages more than 45 years. Adherence with evidence-based medical therapies was evaluated, including the acute use (within 24 hours) of aspirin and beta-blockers; the use of evidence-based therapies at discharge (aspirin, beta-blockers, clopidogrel, angiotensin-converting enzyme [ACE] inhibitors or angiotensin-receptor blocker [ARB] agents, and statins or lipid-lowering drugs); and smoking cessation counseling. An “all or none” composite performance measure encompassed six key quality of care measures: 1) patients discharged while taking aspirin, 2) patients discharged while taking beta-blockers, 3) patients receiving aspirin within 24 hours of presentation, 4) patients with documented left ventricular dysfunction discharged on ACE inhibitor or ARB, 5) smoking cessation counseling, and 6) patients with a low-density lipoprotein level >100 mg/dl receiving lipid-lowering drugs. The primary outcome measure was in-hospital all-cause mortality. Secondary outcome measures included median door-to-balloon times, median door-to-thrombolytic times, the proportion of patients meeting the American College of Cardiology/American Heart Association guideline-recommended within 90-minute door-to-balloon time, and length of hospital stay.