Abstract
BackgroundSince the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap.MethodsSwiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed.ResultsOverall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend < 0.001). Percutaneous revascularizations increased from 6.0% to 39.9% (p for trend < 0.001). Bare stents rose from 1.3% to 16.6% (p for trend < 0.001). Drug eluting stents appeared in 2004 and increased to 23.5% in 2008 (p for trend < 0.001). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend < 0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend < 0.001). Among patients managed in a single hospital (not transferred), seven-day and total in-hospital mortality decreased from 8.0% to 7.0% (p for trend < 0.01) and from 11.2% to 10.1%, respectively. These changes were no longer significant after multivariate adjustment for age, gender, region, revascularization procedures and transfer type. After multivariate adjustment, differing trends in revascularization procedures and in in-hospital mortality were found according to the geographical region considered.ConclusionIn Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates.
Highlights
Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland
Multivariate models assessing trends for seven-day and overall hospital mortality rates were adjusted for age, gender, intensive care unit (ICU) stay, hemodynamic assistance and revascularization procedures; when assessing trends for Switzerland, a further adjustment was performed on region
For in-hospital mortality, analysis was conducted adjusting for age, gender, ICU stay, hemodynamic assistance and revascularization procedures for each Swiss region; for Switzerland, a further adjustment was performed on region. §, patients not transferred to another hospital; §§, patients managed in a single hospital
Summary
No study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. There are few data on the evolution of AMI management and outcome in Switzerland. A study published in 2006 [8] based on data from 68 medical centers participating in the AMIS Plus register (http://www.amis-plus.ch/ Project.htm) assessed Swiss trends in invasive treatment and outcome for the period 1997 to 2005. Still, it is unknown if the findings from this study apply to non participating centers, and whether these trends are applied in all Swiss regions. In Switzerland, health policies rarely go down to clinical guidelines and, if they
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