Cor Vasa 2003, 44(11):543-549

The in-hospital course of acute myocardial infarction in the Czech Republic. A myocardial infarction registry in PRAGUE-1

František Bednář¹, Petr Widimský², Pavel Třeštík³, Petr Povolný⁴, David Vencour⁵, Miroslava Patočková⁶, Ondřej Čermák⁷, Radovan Sís⁸, Venuše Šmejkalová⁹, lékaři nemocnic spolupracujících na studii PRAGUE-1

¹ Kardiochirurgická klinika

² Kardiocentrum, Fakultní nemocnice Královské Vinohrady

³ Interní oddělení, Nemocnice Kroměříž

⁴ Interní oddělení, Nemocnice Kladno

⁵ Interní oddělení, Nemocnice Nymburk

⁶ Interní oddělení, Nemocnice Koliště, Brno

⁷ Interní oddělení, Nemocnice Slaný

⁸ Interní oddělení, Nemocnice Brno-Lískovec

⁹ Interní oddělení, Nemocnice Kutná Hora, Česká republika

Aim of study:
Analysis of the myocardial infarction registry of the PRAGUE-1 (PRimary Angioplasty in patients transferred from General community hospitals to specialized PCI Units with or without Emergency thrombolysis) study.

Method:
A retrospective analysis of the registry of all patients with myocardial infarction admitted, from June 1997 through March 1999, to 17 general community hospitals without a catheterization room and cooperating in PRAGUE-1.

Results:
Overall, 2,512 myocardial infarction (MI) patients with a mean age of 67 years, and men making up 58%, were admitted. Final diagnoses of Q-wave MI were established in 61%, non-Q-wave MI in 36 %, and bundle branch block in 3% of patients. Anterior MI was diagnosed in 55%, and primary MI in 83% of patients. On admission, heart failure was present in 33% of patients; 5% were in cardiogenic shock. Of all patients, only 57% presented within 12 hours from the onset of complaints. Mean length of hospital stay was 13 days. Reperfusion therapy was used in 45% of Q-wave MI patients; of this number thrombolysis in 31%, and primary/rescue PCI in 14%. Overall in-hospital mortality of all MI's was 13%. Q-wave MI mortality was 17% after thrombolysis, 9% after primary/rescue PCI, and 21% with MI's not treated by a reperfusion strategy.

Conclusion:
Two thirds of patients with myocardial infarction admitted first to general hospitals develop a Q-wave MI, and less than 50% of these are treated by a reperfusion strategy. Almost half of patients with symptoms of an acute MI arrive to hospital late. Overall in-hospital mortality with all MI's is 13%, which is about a double compared with the rates reported by specialist heart centers.

Keywords: Myocardial infarction; Thrombolysis; Angioplasty; Mortality; Registry

Published: November 1, 2003  Show citation