Examination of the long-term care and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry
Jánosi András1, Ferenci Tamás2,3, Piróth Zsolt1, Andréka Péter1
1Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest
2Óbudai Egyetem, Élettani Szabályozások Kutatóközpont, Budapest
3Budapesti Corvinus Egyetem, Statisztika Tanszék, Budapest
In the 9 years following the start of the Hungarian Myocardial Infarction Registry program, we recorded the data of 53,982 ST-elevation myocardial infarction (STEMI) patients. 80.9% of patients were transferred to an invasive center, 68.6% by primary transport. The rate of percutaneous coronary intervention (PCI) varied between 83–89% annually. Thrombolysis occurred in less than 1% of patients. When comparing the data internationally (Estonian, Hungarian, Norwegian, Swedish registers), it was found that primary PCI was most often performed in Hungary, and reperfusion treatment (thrombolysis + PCI) in Sweden. The frequency of thrombolysis in the other three countries (Sweden, Estonia, Norway) was significantly higher (3.2%, 12.4%, 13.2%). Age-adjusted 30-day mortality was the highest in Hungary (15.2%). The authors draw attention to the fact that in Hungary, the time between the onset of the complaint and the opening of the vessel (total ischemic time = TIT) is significantly longer than optimal and hardly changed over the years. If the catheter opening cannot be performed in an optimal time, then thrombolysis should be performed. Timely reperfusion treatment is particularly important in patients with a high infarction risk and a low risk of bleeding. The authors analysed the data of 30,399 patients treated for STEMI and investigated the significance of TIT on survival. A Cox regression analysis was used and it was determined that for 200 minutes the TIT did not affect the survival of the patients, but after this time the life prospects of the patients worsened rapidly initially and later slowly. Conclusion: in terms of improving survival data, reducing TIT and applying reperfusion treatment in a timely manner are the most important tasks. The optimal treatment strategy can be chosen based on valid guidelines.
ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 5
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