Management and in-hospital outcome of patients with acute myocardial infarction admitted to intensive care units at the turn of the century: results from the French nationwide USIC 2000 registry

Objective: To assess actual practices and in-hospital outcome of patients with acute myocardial infarction on a nationwide scale. Methods: Of 443 intensive care units in France, 369 (83%) prospectively collected data on all cases of infarction (within < 48 hours of symptom onset) in November 2000. Results: 2320 patients (median age 68 years, 73% men) were included, of whom 83% had ST segment elevation infarction (STEMI). Patients without STEMI were older and had a more frequent history of cardiovascular disease. Median time to admission was 5.0 hours for patients with and 6.5 hours for those without STEMI. Reperfusion therapy was used for 53% of patients with STEMI (thrombolysis 28%, primary angioplasty 25%). In-hospital mortality was 8.7% (5.5% of patients without and 9.3% of those with STEMI). Multivariate analysis found that age, Killip class, lower blood pressure, higher heart rate on admission, anterior location of infarct, STEMI, diabetes mellitus, previous stroke, and no current smoking independently predicted in-hospital mortality. At hospital discharge, 95% received antiplatelet agents, 75% received β blockers, and over 60% received statins. Angiotensin converting enzyme inhibitors were prescribed for 40% of the patients without and 52% of those with ST elevation. Conclusions: This nationwide registry, including all types of centres irrespective of their size and experience, shows continued improvement in patient care and outcomes. Time from symptom onset to admission, however, has not improved in recent years and reperfusion therapy is used for just over 50% of patients with STEMI, with an increasing use of primary angioplasty.

[1]  S. Yusuf MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .

[2]  Hugo A. Katus,et al.  Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. , 2000, European heart journal.

[3]  P. Sritara,et al.  Reduced in-hospital mortality from acute myocardial infarction with general adoption of thrombolytic treatment in the North West Thames health region 1979-1991. , 1995, British heart journal.

[4]  J. Gore,et al.  Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective. , 2001, Journal of the American College of Cardiology.

[5]  H. Dauerman,et al.  Ten-year trends in the incidence, treatment, and outcome of Q-wave myocardial infarction. , 2000, The American journal of cardiology.

[6]  P. Kudenchuk,et al.  Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the Myocardial Infarction Triage and Intervention Project). , 1993, The American journal of cardiology.

[7]  M L Simoons,et al.  A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). , 2002, European heart journal.

[8]  HOMAS,et al.  The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels , 2000 .

[9]  Johan Herlitz,et al.  Indications for fibrinolytic therapy in suspected acute myocardial infarction : collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994 .

[10]  Javed Butler,et al.  Outpatient adherence to beta-blocker therapy after acute myocardial infarction. , 2002, Journal of the American College of Cardiology.

[11]  R. Collins,et al.  Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. , 1998, The New England journal of medicine.

[12]  D. Arveiler,et al.  Prise en charge thérapeutique de l'infarctus du myocarde : évolution dans le projet MONICA-France entre 1985 et 1991 , 1996 .

[13]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[14]  Adam Brown,et al.  Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study. , 2000, Circulation.

[15]  Raymond C. Schneider,et al.  ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction , 1995, The Lancet.

[16]  B. Modan,et al.  Twenty-five-year mortality rate decrease in patients in Israel with a first episode of acute myocardial infarction. Secondary Prevention Reinfarction Israeli Nifedipine Trial Study Group. Israeli Thrombolytic Survey Group. , 1995, American heart journal.

[17]  J S Alpert,et al.  Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. , 2000, Journal of the American College of Cardiology.

[18]  Scandinavian Simvastatin Survival Study Group Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) , 1994, The Lancet.

[19]  P. Marques-Vidal,et al.  Distribution et prise en charge des facteurs de risque cardiovasculaires chez des patients coronariens : étude Prévenir , 2001 .

[20]  H. Krumholz,et al.  Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. , 1998, JAMA.

[21]  C. Fry,et al.  Science of urinary incontinence Report of a Meeting of Physicians and Scientists, University College London , 1994, The Lancet.

[22]  J. Stengård,et al.  Antibodies to glutamic acid decarboxylase as predictors of insulin-dependent diabetes mellitus before clinical onset of disease , 1994, The Lancet.

[23]  R. Califf,et al.  A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. , 1997 .

[24]  Richard P. Lewis,et al.  ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). , 1996, Journal of the American College of Cardiology.

[25]  J. Ferrières,et al.  Effect of reperfusion therapy on long-term outcome in patients >70 years of age. , 2002, The American journal of cardiology.

[26]  E. Antman,et al.  Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. , 1999, Circulation.

[27]  K. Swedberg,et al.  Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II) , 1992, The New England journal of medicine.

[28]  J. Leor,et al.  Sex Differences in Management and Outcome After Acute Myocardial Infarction in the 1990s: A Prospective Observational Community-Based Study , 2000, Circulation.

[29]  W. Rogers,et al.  Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. , 2000, Journal of the American College of Cardiology.

[30]  J. Berning,et al.  Early estimation of risk by echocardiographic determination of wall motion index in an unselected population with acute myocardial infarction. , 1990, The American journal of cardiology.

[31]  C. Alauze,et al.  Intérêt d’une campagne d’information régionale sur les urgences cardiaques et l’appel au 15 , 2003 .

[32]  Frans Van de Werf,et al.  Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. , 2003 .

[33]  J. Ferrières,et al.  Management of acute myocardial infarction in intensive care units in 1995: a nationwide French survey of practice and early hospital results. , 1997, Journal of the American College of Cardiology.

[34]  Fibrinolytic Therapy Trialists' Collaborative Group Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994, The Lancet.

[35]  AndrewJ. S. Coats MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial , 2002, The Lancet.

[36]  J. Slattery,et al.  Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 1994. , 1994, Atherosclerosis. Supplements.

[37]  H. White Thrombolytic therapy in the elderly , 2000, The Lancet.

[38]  N. Dudley Thrombolytic therapy in the elderly. , 1991, Postgraduate medical journal.

[39]  Gruppo Italiano per lo Studio della Soprawivenza nell'Inf Miocardico. GISSI-3: effects of lisiriopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction , 1994, The Lancet.

[40]  B. Modan,et al.  Twenty-five—year mortality rate decrease in patients in Israel with a first episode of acute myocardial infarction , 1995 .

[41]  D. Baim,et al.  Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. , 1999, The New England journal of medicine.

[42]  B. Davis,et al.  The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. , 1996, The New England journal of medicine.

[43]  J. Ferrières,et al.  Use of secondary preventive drugs in patients with acute coronary syndromes treated medically or with coronary angioplasty: results from the nationwide French PREVENIR survey , 2002, Heart.

[44]  R. Califf,et al.  1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). , 1996, Journal of the American College of Cardiology.

[45]  L. Goldman,et al.  Impact of a public campaign on pre-hospital delay in patients reporting chest pain. , 1996, Heart.

[46]  D. Arveiler,et al.  [Evaluation of the status of access to emergency care of subjects with myocardial infarction]. , 1988, Revue d'epidemiologie et de sante publique.

[47]  T. Heer,et al.  Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry). , 2002, The American journal of cardiology.