Incidence, pre-hospital delay and prognosis of acute myocardial infarction in big regions of Hungary: Population data from the Hungarian myocardial infarction registry.

Abstract

To examine the incidence and treatment of acute myocardial infarction (AMI) as well as 30-day and 1-year prognoses of patients in different regions of Hungary. According to the statistical system of the European Union, Hungary can be divided into three major socio-economic regions-west Hungary, central Hungary and east Hungary. The Hungarian Myocardial Infarction Registry (HUMIR) is a prospective comprehensive and mandatory disease registry for patients with AMI. The total population of Hungary is currently 9.8million: 39% live in the eastern region (ER), 31% in the central region (CR) and 30% in the western region (WR). Population over 30years, the age-standardised incidence of AMI was 177.5 (175.7-179.3) per 100000 person-year. During hospital treatment, 82.5%-84.6% of patients with ST-elevation (STEMI) and 54.8%-58.8% without ST-elevation (NSTEMI) myocardial infarction underwent PCI. The total ischaemic time of patients with STEMI was shortest in WR (221minutes) compared with two other regions (CR: 225minutes and ER: 262minutes). In the STEMI group, the 30-day mortality rates of male patients were lowest in the WR (P=.03). If PCI was performed, mortality rates for both sexes were lowest in the WR (P<.01; P=.04). The 1-year mortality rate in the male population who received PCI was lowest in the WR. In the NSTEMI group, the 30-day mortality rate exhibited no differences. Regarding 1-year mortality, those who underwent PCI in the WR showed the lowest mortality. The major regions of Hungary revealed significant differences regarding the incidence, prehospital delay, treatment and mortality of AMI. Logistic regression analysis confirmed the independent prognostic significance of the region on the 30-day mortality of patients with STEMI (hazard ratio=0.88, P=.0114; CI: 0.80-0.97).