Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway, and Sweden according to national ongoing registries

Abstract

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.

Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries

“…Large-scale myocardial infarction (MI) registries provide important insights into how evidence-based therapies are applied in the real-world setting. In our previous work, 14 we compared four different European ongoing national MI registries and observed that the presentation, management, and outcomes of STEMI patients differ between countries. Given the increased awareness and attention on sex-related topics in recent years, we specifically aimed to study sex-specific differences in short- and long-term mortalities of contemporary STEMI cohorts in four European countries (Estonia, Hungary, Norway, and Sweden).…”

Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction

“…Indeed, when the SWEDEHEART registry has been compared with other continuous national registries including patients with MI, baseline characteristics, given treatments and outcomes have been similar. 11 , 12 , 13 , 14 , 15 …”

Incidence, Pre-hospital Delay and Prognosis of Acute Myocardial Infarction in Hungary: Population Data from the Hungarian Myocardial Infarction Registry

“…For the complex examination of infarction care, continuous registers were created in several European countries (2,3,5), enabling quality assurance for care, as well as monitoring of changes in treatment. Based on population data, it has become possible to compare data from different countries (6,8,9); nevertheless, when evaluating the data, methodological differences pose a problem (10).…”

“…One of the earliest population-based surveys regarding the incidence and treatment of myocardial infarction was initiated and co-ordinated by the World Health Organisation approximately 30 years ago (1). Over the past two decades, many European and Far Eastern countries have launched registries covering the entire population (2-5), and several comparative international studies have been performed (6)(7)(8)(9). Due to the varying methodologies of these registries, the comparative evaluation of data has only been possible with certain limitations (10).…”