Therapy of Acute Myocardial Infarction in Unspecialised Medical Centres – Evaluation of Diagnostic and Therapeutic Practice

Overview

Background.
No general register of patients with acute coronary syndrome is available in the Czech Republic. That is why the everyday clinical practice remains indeterminate. The aim of the study was to compare patients’ characteristics, diagnostic and therapeutic procedures in patients with acute myocardial infarction admitted to three municipal hospitals (Caslav, Kutna Hora, Znojmo) and to assess the correspondence of the local clinical practice with the current guidelines. 

Methods and Results.
A total of 564 patients (300 men, 264 women) mean age 71±11,9 years) admitted for acute myocardial infarction was included into the study. No significant difference was found in the demographic data among the hospitals. Higher proportion of smokers was observed in the hospital of Kutna Hora (p<0,01). In the studied sample, the proportion of myocardial infarctions without ST elevation was larger than that without it (311 pts. – 73 %). In the subgroup of patients with myocardial infarction and ST elevation 67 % received some form of reperfusion therapy (primary angioplasty in 63 % and fibrinolytic therapy in 4 %). Most patients received aspirin and heparin (78 % a 82 % respectively) within the first 24 hours; the treatment with beta-blockers was less common (34%). The most frequent in-hospital complication was the heart failure (23 %). In-hospital mortality for all patients was 15%. At the discharge from hospital, patients received flowing treatment: aspirin (76 %), beta-blockers (63 %), ACE inhibitors (58 %), statins (54 %). A significant difference was found only in the use of clopidogrel and ticlopidin (p<0,001). 

Conclusions.
This study reveals only minor differences in the management of patients among hospitals and demonstrates some differences between existing guidelines and current clinical practice. The vast majority of patients with acute myocardial infarction with ST elevation was treated by primary angioplasty. 

Key words:
acute myocardial infarction, risk factors, reperfusion therapy, medication.