[Temporal trends in myocardial infarct morbidity, mortality and 28-day fatalities and medical management. Results of the Augsburg Myocardial Infarct Register 1985 to 1992].

Between 1985 and 1992 a significant decrease in rates of acute myocardial infarction (AMI; fatal and non fatal, including prehospital cardiac death) from 533 cases per 100,000 population of 455 cases was observed in the 25- to 74-year-old male study population (linear regression model: -13%, p < 0.01). In the corresponding female study population the AMI rate increased from 153 cases per 100,000 population in 1985 to 153 cases in 1992 (linear regression model: +18%, p < 0.05). The decrease was only in 50- to 59-year-old male AMI patients without changes in risk factors (smoking, diabetes, hypertension, recurrent AMI) but with a decrease in patients with a history of angina pectoris, which may have been caused by intensified medical treatment of AMI endangered patients. Over time 34% of the patients died before hospitalization and another 19% died within the first 24 h after hospitalization. The register results show an underestimation of the coronary mortality by the official cause of death statistics. In contrast, the significant increase in treatment with thrombolytics (men from 16% to 38%, women from 8% to 42%), beta-blockers (men from 48% to 69%, women from 45% to 71%), and antiplatelets (men from 55% to 94%, women from 52% to 91%) was not related to any significant changes in 28-day case fatality of the 24-h survivors (men and women 13% to 14%). Without media campaigns, for the increased number of cases hospitalized within 4 h after the event (1985-1987 men 50%, women 42%; 1990-1992 58% and 60%; p < 0.01) thrombolytic treatment shows an increase from 25% in men and 17% in women (1985-1987) to 54% in men and 47% in women (1990-1992; p < 0.01).