Advancing the Care of Cardiac Patients Using Registry Data:  Going Where Randomized Clinical Trials Dare Not

Cardiovascular medicine has seen numerous advances, fueled by data from randomized clinical trials (RCTs). A particularly important example has been in the care of patients presenting with acute myocardial infarction (MI). Data supporting either prompt mechanical or pharmacologic reperfusion are now abundant. A limitation to the potential application of this new knowledge, however, has been lack of optimal implementation of these reperfusion strategies in real-world patients. This inability to translate RCT data into practice is attributable to several factors. Physicians may be unaware of trial results, especially soon after new findings are published or incorporated into clinical guidelines, although this is an unlikely explanation with respect to care for acute MI in the current era. Physicians may be skeptical about the relevance of RCT findings to their patient population. This may be particularly true in groups such as older patients, who remain underrepresented in RCTs, or in patients with multiple comorbid conditions, who typically are excluded from RCTs. Furthermore, not every clinical question is amenable to RCT design. Because of these limitations to extrapolation of RCT results to actual practice, large regional databases and registries are vital to round out the knowledge basis for clinical decision making.