Coronary thrombolysis: Impact of clinical research on day-to-day practice

We evaluated the use of coronary thrombolytic therapy in community hospital practice during a time period when major clinical trials were shaping standards of care. Between 1990 and 1993, a prospective registry of patients with suspected acute myocardial infarction who were treated at six hospitals in a large metropolitan area was established. Of 1,225 enrolled patients with confirmed infarction, 37% of the men and 26% of the women received thrombolytic therapy. During the registry period, the use of tissue- type plasminogen activator declined while the use of streptokinase increased dramatically, coinciding with the release of results of a major clinical trial. This suggests that diffusion of information from clinical research to the community is rapid and has an impact on actual physician practice patterns.