Hospital care and survival of acute myocardial infarction patients in Minnesota and southern Germany

Abstract

The hospital care of patients with acute myocardial infarction (AMI) is likely to vary among advanced industrialized countries, but only few studies have systematically documented such differences. Moreover, despite likely differences in medical care, it is not known whether the prognosis of AMI patients differs among countries. Using two registries of hospitalized AMI, we compared the characteristics, medical care, and survival through 1 year of patients in Augsburg, South Germany (n = 464) and Minneapolis-St. Paul (the Twin Cities), Minnesota, USA (n = 504). The samples included patients aged 25-74 years who had been treated in a coronary care unit and survived the first 24 h after admission. The two groups of patients did not differ in age distribution, sex ratio, or delay before admission to hospital (70% admitted within 6 h of symptom onset). The risk profile with respect to cardiovascular disease (smoking, hypertension, and diabetes) was more unfavourable among Augsburg patients than it was among Twin Cities patients but Twin Cities patients were more likely (P < 0.05) than Augsburg patients to report a previous myocardial infarction (29 versus 20%), coronary bypass surgery (9 versus 4%), and coronary angioplasty (6 versus 1%). Revascularization procedures were performed more frequently (P < 0.005) during the index hospitalization in the Twin Cities than they were in Augsburg: thrombolytic therapy 38 versus 28%, angioplasty 27 versus 13%, and bypass surgery 9 versus 3%. In contrast, cardiovascular medications, such as beta-blockers and aspirin, were administered more frequently in Augsburg than they were in the Twin Cities. There were substantial differences in duratin of hospital stay between the two sites with a median stay of 22 days for Augsburg patients versus 7 days for Twin Cities patients. However, there were no significant differences in 28-day case-fatality (6% in both) or 1-year survival (89% in Augsburg versus 88% in the Twin Cities, P = 0.70). Likewise, in multivariate analysis, allowing for the effects of age, sex and a history of myocardial infarction, the registry site was predictive neither of 28-day nor of 1-year mortality. These data document significant differences in the medical care of AMI patients in Minnesota and Augsburg, which, nonetheless, did not translate into survival differences.