[Comparison of the clinical characteristics and hospital treatment of myocardial infarction with and without ST-segment elevation in Hungary. National Registry of Myocardial Infarction]

INTRODUCTION

Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary.

AIM

To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database.

METHOD

Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis.

RESULTS

Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction.

CONCLUSIONS

The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups.

[National Myocardial Infarction Registry of Hungary]

The authors delineate the circumstances of the creation of the National Myocardial Infarction Registry program. This web-based program started in January 1, 2010 as a "pilot" study with the voluntary participation of 12 centres. As a result of professional consensus, the number of participating institutions has continuously increased and, since March 1, 2013, data supply has become obligatory for hospitals treating patients with myocardial infarction. In December, 2013 a new modification of certain health and health insurance related acts such as Act XLVII/1997 regulated the operation of National Myocardial Infraction Registry. At present 65 institutions provide data regularly. The number of patients with myocardial infarction in the database was 24308 in January 1, 2014. The authors summarize the data which accumulated during almost four years of functioning of the National Myocardial Infarction Registry Program. The incidence of myocardial infarction was defined by reviewing the number of pre hospital and hospital cases in five districts of the capital and Szabolcs-Szatmár-Bereg County of Hungary. Reviewing the records patients with ST-elevation and non-ST-elevation myocardial infarction revealed that treatment of 91% of ST-elevation patients occurred in hospitals with cardiac catheterization laboratory, and 82% of patients had primary percutaneous coronary intervention. In-hospital, 30-day and 1-year mortality were defined for patients treated for both types of myocardial infarction. Based on national and international experience, the authors emphasize that professional characteristics of patient care can only be assessed using specific patient registries and these data are essential in the development of an efficient health-care system.

[Short and long term prognosis of patients with myocardial infarction. Hungarian Myocardial Infarction Registry]

INTRODUCTION

Mortality data of patients with acute myocardial infarction are incomplete in Hungary.

AIM

The aim of the authors was to analyse the data of 8582 myocardial infarction patients (4981 with ST-elevation myocardial infarction) registered in the Hungarian Myocardial Infarction Register in order to define the hospital, 30-day, and 1-year mortality. To evaluate the prehospital mortality of myocardial infarction, all myocardial infarction and sudden death were registered in five districts of Budapest.

METHOD

Multivariate logistic regression was performed to define risk factors of mortality and the model were assessed using c statistics.

RESULTS

The hospital, 30-day and 1-year mortality of patients with ST elevation myocardial infarction were 3.7%, 9.5% and 16.5%, respectively. In patients without ST elevation myocardial infarction these figures were 4%, 9.8% and 21.7%, respectively. The 1-year mortality of patients without ST elevation was higher than those of with ST elevation and the difference was statistically significant. Age, Killip class, diabetes mellitus, history of stroke and myocardial infarction were independent predictors of death. Coronary intervention improved the prognosis of patients with myocardial infarction significantly.

CONCLUSIONS

The rate of pre-hospital mortality was considerably high; 72.5% of 30 day mortality occurred before admission to hospital.

Incidence of myocardial infarction in Hungary. Population study in five districts of Budapest and Szabolcs-Szatmár-Bereg county

Introduction: In the last few decades data on the incidence of acute myocardial infarction are not available in Hungary. Aim: The aim of the authors was to define the incidence of myocardial infarction using the Hungarian Infarction Registry according to the number of in- and out-of-hospital cases in five districts of the capital (districts II, III, IX, X and XVII) and Szabolcs-Szatmár-Bereg county. Method: Besides using the Hungarian Infarction Registry, databases of the National Public Health and Medical Officer Service and that of the Hungarian Central Statistical Office were used in order to define the incidence of prehospital cases, according to the regulations presented in an earlier proposal of the Data Protection Ombudsman of Hungary. Results: For 10 000 residents the incidence of myocardial infarction in the capital was 28.63 in males and 16.21 in females, while in Szabolcs-Szatmár-Bereg county the mean incidence was 32.49 for males and 18.59 for females. The mean incidence of myocardial infarction in the five districts of the capital in males and females did not differ from the mean values of Szabolcs-Szatmár-Bereg county. When comparing the incidence values in different districts of the capital to the countryside, the Szabolcs-Szatmár-Bereg county had significantly higher values for both males and females compared to districts II and III of the capital, while in district X the incidence of myocardial infarction in males was significantly lower compared to the values in the countryside. Conclusions: Using the mean incidence results projected to the capital and countryside population according to age and gender, 20 000 new myocardial infarction cases might be expected per year in Hungary. Orv. Hetil., 2013, 154, 1106–1110.

Clinical presentation and hospital outcome of patients with ST-elevation myocardial infarction – Hungarian Myocardial Infarction Registry data

Introduction: There are only very few data on gender differences in patients with ST-elevation myocardial infarction. Aim: To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Patients and methods: Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Results: Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p<0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p<0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p<0.001). Conclusions: At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis. Orv. Hetil., 2012, 153, 1465–1468.

Study of incidence and treatment of acute myocardial infarction by evaluating the financing database: 2004–2009

In Hungary we have no comprehensive data on hospital care and short and long term prognosis of patients with myocardial infarction. Aims: To collect data on number, hospital care and prognosis of patients treated for myocardial infarction in all Hungarian hospitals. Methods: Authors studied the number of patients treated in hospital for acute myocardial infarction, the frequency of revascularization by coronary angioplasty during treatment, as well as the 30 and 365 day mortality of patients by the evaluation of the financing database of the National Health Insurance Fund for 6 years (2004-2009). Results: There has been no major change during the observation period in the number of patients treated in hospital for myocardial infarction (approximately 16,500 cases/year). The incidence in males (calculated by the number of patients treated in hospital) is higher in any age group compared to females; this difference is lower in older age groups. During the observation period the 30 and 365 day mortality has decreased by 1.8% (18.9% vs. 17.1% and 29.9% vs. 28.1%, respectively), which was caused by a decrease in the mortality of patients above age 70. The percentage of revascularization by coronary angioplasty during the treatment of myocardial infarction has significantly increased (18.2% vs. 49.8%). The International Classification of Diseases does not differentiate between the different forms of myocardial infarction, therefore the prognostic effects of coronary angioplasty cannot be evaluated in this respect. Conclusions: Authors conclude that the financing database is suitable to evaluate the major aspects of care and to support healthcare management decisions, while the appropriateness of treatment and the effectiveness of different interventions can be assessed by prospective databases satisfying the needs of special aspects and can therefore be used for detailed assessments. Orv. Hetil., 2012, 153, 102–112.