Fischer F, Schiele R, Zahn R, Schneider S, Wagner S, Senges J
Medizinische Klinik B Herzzentrum Ludwigshafen.
Dtsch Med Wochenschr. 2000 Oct 6;125(40):1181-5. doi: 10.1055/s-2000-7700.
Little is known about any differences in the prevention, treatment and treatment results of myocardial infarction between the "old" (western) and "new" (eastern) Lands (OFL vs. NFL) of the now unified Federal Republic of Germany. It was the aim of this study to determine any such differences.
The Myocardial Infarction Register (MIR) is a multicentre and prospective compilation of consecutive unselected data on patients with acute myocardial infarction sustained between December 1996 and May 1998. All date collected between these dates were included in the study: there were 14,608 patients in 211 hospitals, 5618 patients and 68 hospitals of those in the eastern part (former German Democratic Republic). The median age of the entire collective was 68 years, 35% of patients were female.
There was a higher prevalence of risk factors in the NFL than the OFL: 43.3 vs. 39.0% with regard to arterial hypertension (p = 0.002), and 28.9 vs. 22.4% with regard to diabetes mellitus (p < 0.001). The prehospital period was longer in the NFL by an average of 30 min (210 vs. 180 min; p < 0.001. Another difference concerned the lower number of diagnostic ECGs in the NFL (61.8 vs. 68.6%; p < 0.001). There were no significant differences with regard to acute and discharge medication (acetylsalicylic acid, betablockers, angiotensin-converting-enzyme inhibitors and cholesterol-synthesis inhibitors). The frequency of primary recanalization treatment (thrombolysis or percutaneous transluminal coronary angioplasty) in patients with clear-cut indications for thrombolysis was higher in the OFL (85.1 vs. 74.5%; p < 0.001). Hospital mortality was comparable (15.1 vs. 15.9%; p = 0.14).
Patient characteristics and treatment in the two parts of Germany were comparable in the two parts. Treatment of acute myocardial infarction attained a similarly high standard in both. But in both parts there is room for improving the application of guidelines for treating of myocardial infarction to routine clinical practice. Greater effort should be made to inform the population, especially of the NFL, about the need for primary prevention and reduction in prehospital time.
对于现已统一的德意志联邦共和国的“旧”（西部）和“新”（东部）地区（OFL与NFL）在心肌梗死的预防、治疗及治疗结果方面的差异，人们了解甚少。本研究旨在确定这些差异。
心肌梗死登记处（MIR）是一项多中心前瞻性研究，收集了1996年12月至1998年5月期间连续入选的急性心肌梗死患者的未筛选数据。这期间收集的所有数据均纳入研究：211家医院共有14,608例患者，其中东部地区（原德意志民主共和国）68家医院有5618例患者。整个研究群体的年龄中位数为68岁，35%的患者为女性。
NFL地区的危险因素患病率高于OFL地区：动脉高血压方面分别为43.3%与39.0%（p = 0.002），糖尿病方面分别为28.9%与22.4%（p < 0.001）。NFL地区的院前时间平均长30分钟（210分钟对18分钟；p < 0.001）。另一个差异是NFL地区诊断性心电图的数量较少（61.8%对68.6%；p < 0.001）。在急性和出院用药（阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和胆固醇合成抑制剂）方面无显著差异。对于有明确溶栓指征的患者，OFL地区的初次再灌注治疗（溶栓或经皮冠状动脉腔内血管成形术）频率更高（85.1%对74.5%；p < 0.001）。医院死亡率相当（15.1%对15.9%；p = 0.14）。
德国两部分地区的患者特征和治疗情况具有可比性。急性心肌梗死的治疗在两部分地区都达到了相似的高标准。但在两部分地区，将心肌梗死治疗指南应用于常规临床实践方面都有改进空间。应做出更大努力，让民众，尤其是NFL地区的民众了解一级预防的必要性以及缩短院前时间。
