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

2. 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

3. Baseline Characteristics - STEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

4. Hospital Presentation Characteristics - STEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

5. In-Hospital Outcomes - STEMI * Unadjusted mortality # Transfusion among non-CABG patients * Unadjusted mortality # Transfusion among non-CABG patients ACTION Registry-GWTG DATA: January 1 – December 31, 2008

6. Use of Reperfusion Therapy for STEMI STEMI N = 20,998 Reperfusion N = 16,374 (78%) No Reperfusion – No Contraindication Listed N = 1163 (6%) Not Eligible for Reperfusion Therapy Contraindication Listed N= 3,011 (14%) Primary PCI – 86%* Fibrinolytics – 13%* Both PCI + Lytics – 1%* * Among patients receiving reperfusion ACTION Registry-GWTG DATA: January 1 – December 31, 2008

7. DTB = 1 st Door to Balloon for Primary PCI DTN = Door to Needle for Lytics STEMI – Door to Balloon and Door to Needle Times: Cumulative 12 Month Data ACTION Registry-GWTG DATA: January 1 – December 31, 2008

8. STEMI Primary PCI Results - Non-Transfer Patients with DTB 90 mins 73% of the primary PCI patients are not transferred in

9. STEMI Primary PCI Results - DTB Benchmarks for Transfer-In Patients 1 st Door to Balloon < 90 Minutes 1 st Door to Balloon < 120 Minutes 27% of the primary PCI patients are transferred in

10. STEMI Door-to-Balloon Times – Median Times for Transfer In and Non-Transfer In Patients Transfer in DTB TimesNon-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 Time (min) 50 220 210 60 70 80 90 110 100 120 130 140 150 160 170 200 180 190 240 230 82 40 30 20 250 10 0

11. STEMI Acute (< 24 hrs) Medications ACTION Registry-GWTG DATA: January 1 – December 31, 2008

12. STEMI Discharge Medications % Use ACTION Registry-GWTG DATA: January 1 – December 31, 2008

13. STEMI Discharge Interventions ACTION Registry-GWTG DATA: January 1 – December 31, 2008

14. Baseline Characteristics - NSTEMI

15. Hospital Presentation Characteristics - NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

16. In-Hospital Outcomes - NSTEMI * Unadjusted mortality # Transfusion among non-CABG patients * Unadjusted mortality # Transfusion among non-CABG patients ACTION Registry-GWTG DATA: January 1 – December 31, 2008

17. NSTEMI Acute (< 24 hrs) Medications ACTION Registry-GWTG DATA: January 1 – December 31, 2008

18. 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) ACTION Registry-GWTG DATA: January 1 – December 31, 2008 26% 25% 15% 9% 10% 9% 0% 5% 10% 15% 20% 25% 30% Q1 2008Q2 2008Q3 2008Q4 2008 UFH * LMWH # GP llb-llla

19. NSTEMI Invasive Cardiac Procedures ACTION Registry-GWTG DATA: January 1 – December 31, 2008

20. NSTEMI Revascularization Strategy Trends ACTION Registry-GWTG DATA: January 1 – December 31, 2008 45% 46% 44% 42% 45% 11% 12% 11% 0% 10% 20% 30% 40% 50% 60% Q1 2008Q2 2008Q3 2008Q4 2008 Medically ManagedPCICABG

21. NSTEMI Discharge Medications ACTION Registry-GWTG DATA: January 1 – December 31, 2008

22. NSTEMI Discharge Clopidogrel Use by Revascularization Strategies ACTION Registry-GWTG DATA: January 1 – December 31, 2008

23. NSTEMI Discharge Interventions ACTION Registry-GWTG DATA: January 1 – December 31, 2008

24. Baseline Characteristics – STEMI vs. NSTEMI

25. Hospital Presentation Characteristics - STEMI vs. NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

26. In-Hospital Outcomes - STEMI vs. NSTEMI * Unadjusted mortality # Transfusion among non-CABG patients * Unadjusted mortality # Transfusion among non-CABG patients ACTION Registry-GWTG DATA: January 1 – December 31, 2008

27. Non-CABG Major Bleeding and Transfusion – STEMI vs. NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

28. Acute Medications - STEMI vs NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

29. Discharge Medications - STEMI vs NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008

30. Discharge Interventions – STEMI vs. NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008