Epidemiology of acute myocardial infarction in Romanian county hospitals: a population-based study in the Baia Mare district.

UNLABELLED

The epidemiological characteristics, the methods used in treating the patients, as well as the evolution of the myocardial infarction are not known in the Romanian county and municipal hospitals.

MATERIAL AND METHODS

Six hundred and fifty one cases of acute myocardial infarction were retrospectively recorded in the Emergency County Hospital of Baia Mare from 1.01.1999 till 30.09.2003. Data on treatment delay, therapeutic strategies, duration of hospitalization and outcome were collected. The study was completed by a postal investigation which was carried out from the 1st of October until the 31st of December 2003. This investigation consisted in one application form (multiple choice answers were requested) which had been handed out to the patients who survived the acute episode and left the hospital.

RESULTS

The first medical care took place for 60.9% of the patients in hospital. About 72% of these patients were male and the mean age was 66 +/- 12 years. The types of myocardial infarction with ST-segment elevation STE-MI represented 67%, followed by 29.5% with no ST-segment elevation NSTE-MI, and 3.5% with undetermined ECG. The maximum values of Killip class during the first 48 hours were: I in 55% of the patients, II in 23%, III in 14% and IV in 9% of them. The thrombolytic therapy was done in 31% of the patients who were recommended to receive a reperfusion treatment. During their first period in hospital, 37% of the patients had an effort test and 2.45% were transferred to a tertiary care hospital for invasive procedures. The overall median hospital stay was 9 days. The mortality in hospital was 13.6%, respectively 8.1% in the study group who received the reperfusion therapy and 15.2% among those who had followed the standard care. The results of the mail survey revealed that only 62% of the patients who answered the questionnaire (N=498) had regular cardiologic check ups and 43% underwent a treatment with beta-blockers and 12% a treatment with statins. Out of these patients 16% had a revascularization procedure that was performed in a specialised University Hospital. The overall mortality in the responder group was 35.5% with an estimate 7.5% year rate.

CONCLUSIONS

The analysis of the present data and especially the rate of mortality suggest until two times higher values in comparison to the European average. These results demonstrate the fact that it is imperative to generalize the thrombolytic therapy in all the hospitals in Romania and give a wider access to the myocardial revascularization therapies.