Aims To study baseline characteristics, in-hospital managements and mortality of non-ST elevation MI (NSTEMI) patients in different European countries. Methods and Results NSTEMI patients enrolled in the national MI registries (EMIR; n = 5,817 (Estonia), HUMIR; n = 30,787 (Hungary), NORMI; n = 33,054 (Norway) and SWEDEHEART; n = 49,533 (Sweden)) from 2014 to 2017 were included and presented as aggregated data. The median age at admission ranged from 70 to 75 years. Current smoking status was numerically higher in Norway (24%), Estonia (22%) and Hungary (19%), as compared to Sweden (17%). Patients in Hungary had a high rate of diabetes mellitus (37%) and hypertension (84%). The proportion of performed coronary angiographies (58% versus 75%) and percutaneous coronary interventions (38% versus 56%), differed most between Norway and Hungary. Prescription of dual antiplatelet therapy at hospital discharge ranged from 60% (Estonia) to 81% (Hungary). In-hospital death ranged from 3.5% (Sweden) to 9% (Estonia). The crude mortality rate at 1 month was 12% in Norway and 5% in Sweden (5%), whereas the 1-year mortality rates were similar (20-23%) in Hungary, Estonia and Norway and 15% in Sweden. Conclusion Cross-comparisons of four national European MI registries provide important data on differences in risk factors and treatment regiments that may explain some of the observed differences in death rates. A unified European continuous MI registry could be an option to better understand how implementation of guideline recommended therapy can be used to reduce the burden of cardiovascular disease.

Background Data on how differences in risk-factors, treatments and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST elevation myocardial infarction (STEMI) patients in different European countries. Methods Patients over the age of 18 with STEMI who were treated in hospitals in 2014–2017 and registered in one of the national myocardial infarction registers in Estonia (n = 5,817), Hungary (n = 30,787), Norway (=33,054) and Sweden (n = 49,533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic- and cox regression was used to study the associations of sex and outcomes in the respective countries. Results Women were older than men (70-78 years and 62-68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality rates in-hospital (10.9-15.9% and 6.5-8.9%, respectively), at 30 days (13.0-19.9% and 8.2-10.9%, respectively), and at one year (20.3-28.1% and 12.4-17.2%, respectively) after hospitalization were higher in women versus men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for one year mortality. Conclusion Despite improved awareness of the sex-specific inequalities on managing AMI patients in Europe, country level data from this study show that women still receive less guideline-recommended management.

Aim Describe the characteristics, management and outcomes of hospitalized ST-segment elevation myocardial infarction (STEMI) patients according to national ongoing myocardial infarction registries in Estonia, Hungary, Norway and Sweden. Methods and Results Country-level aggregated data was used to study baseline characteristics, use of in-hospital procedures, medications at discharge, in-hospital complications, 30-day and 1-year mortality for all patients admitted with STEMI during 2014-2017 using data from EMIR (Estonia; n = 4584), HUMIR (Hungary; n = 23685), NORMI (Norway; n = 12414, data for 2013-2016) and SWEDEHEART (Sweden; n = 23342). Estonia and Hungary had a higher proportion of women, patients with hypertension, diabetes and peripheral artery disease compared to Norway and Sweden. Rates of reperfusion varied from 75.7% in Estonia to 84.0% in Sweden. Rates of recommendation of discharge medications were generally high and similar. However, Estonia demonstrated the lowest rates of dual antiplatelet therapy (78.1%) and statins (86.5%). Norway had the lowest rates of beta-blockers (80.5%) and angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (61.5%). The 30-day mortality rates ranged between 9.9-13.4% remaining lowest in Sweden. 1-year mortality rates ranged from 14.8% in Sweden and 16.0% in Norway to 20.6% in Hungary and 21.1% in Estonia. Age-adjusted lethality rates were highest for Hungary and lowest for Sweden. Conclusion This inter-country comparison of data from four national ongoing European registries provide new insights into the risk factors, management and outcomes of patients with STEMI. There are several possible reasons for the findings, including coverage of the registries and variability of baseline-characteristics’ definitions that need to be further explored.