[Comparison of acute myocardial infarct in the old and new lands of unified Germany, 1996-1998. Data of the Myocardial Infarct Register (MIR)].

BACKGROUND AND OBJECTIVE

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.

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.