Myocardial infarction – 2016: frequency, medical care, prognosis
Gottsegen György Országos Kardiológiai Intézet, Nemzeti Szívinfarktus Regiszter, Budapest
*A Nemzeti Szívinfarktus Regiszter Program résztvevői nevében.
The author recites the results of the Hungarian Myocardial Infarction Registry (HUMIR) coming from 2016 and summarizes national data related to the medical care of patients treated with myocardial infarction, which data then are compared with the results of the SWEDEHEART program. The HUMIR contains the clinical data of 87.9% of myocardial infarction cases financed in 2016 (14462 patients, 14766 cases). 41.8% of the registered cases were recorded as ST-elevation myocardial infarction (STEMI), whereas 58.2% of the cases were recorded as non-ST elevation myocardial infarction (NSTEMI). In 92.6% of the STEMI cases the patients were treated in the cardiac catheterization centre. Catheter revascularization took place in 83.2% of the cases. Thrombolysis took place in case of 28 patients (0.38%). 56.7% of the patients with NSTEMI diagnosis were treated with PCI. In 2015, 12.9% of STEMI patients died within 30 days, and 19.9% died within a year. In case of patients receiving PCI treatment these values are significantly lower: 9.1 and 15.1% respectively. In the same year the death rate of NSTEMI patients was 11.8% and 23%. The PCI treatment also ensured significantly better prognosis in this patient group: the death rate was 5.8% and 14.2%. On the basis of the comparison with the directive relating to the treatment of myocardial infarction as well as international data, currently the main problem in Hungary is that a long time elapses from the occurrence of the complaint until the coronary artery is opened up: in 2016 only 6.2% of the patients received primary PCI within 120 minutes. The great majority of STEMI patients do not get to the invasive centre directly (the proportion of primary transport is 68%). Due to the late arrival of the patient and the loss of time resulting from the transfer the full ischaemic time is long. Despite this fact, the application of thrombolysis is negligible (0.38%). It is reasonable to suppose that pre-hospital or in-hospital thrombolysis should be applied more often than now. In the SWEDEHEART program 3.7% of the patients received such treatment. In order to improve the 1-year survival period, increasing the persistence of medical treatment important in terms of secondary prevention and the proportion of specialised care as well as an extensive change in the way of life style may yield a result.