Evolution in the management of acute myocardial infarction in the autonomous community of valencia (Spain): ten years of the primvac registry (1995-2004)

Abstract

Introduction and objectives: Several registries of acute myocardial infarction (AMI) have been carried out in Spain, but few remain active. This work analyses the evolution of the characteristics and control of patients with AMI during the first 10 years of the PRIMVAC registry, initiated in 1995.

Methods: The demographical and clinical characteristics, therapeutic-diagnostic procedures and pharmacological treatment of patients admitted with AMI between January 1995 and December 2004, were analysed in 17 coronary centres in the Autonomous Community of Valencia (South eastern Spain).

Results: The mean age of the 19,719 patients recruited was of 65. The percentage of women, hypertension, hypercholestrolemia and diabetes increased during registry period. The median time of symptoms onset-hospital arrival was 151 minutes, without a decrease over the time, and the delay of thrombolysis fell from 200 to 154 minutes (p<0.01). Percentage of thrombolytic treatment oscillated between 39% and 48%. The mortality in the coronary units decreased (14.1% vs. 8.9%; p<0.001). The number of coronary angiography and percutaneous revascularisation performed increased up to 61% and 32%, respectively, of patients included. On discharge, the use of beta-blockers (29.3% vs. 66.7%), angiotensin-converting enzyme (ACE) inhibitors (41.7% vs. 57.9%) and statins (29.3% vs. 71%) went up.

Conclusions: Overall mortality in the coronary unit decreased, without any variation in the incidence of serious complications. Time to thrombolysis was reduced over the time, with no significant increment in its use. The performance of coronary angiography and percutaneous revascularisation increased, with a low use of primary angioplasty. The use of beta-blockers, ACE inhibitors and statins increased at discharge.

Keywords: mortality; myocardial infarction; registry; treatment.

Figure 1

Evolution of the delay times during registry inclusion period. “pain-hospital” and “pain-thrombolysis”. The time-pain refers to all the cases of the PRIMVAC study and the time-pain thrombolysis refers only to those administered with a thrombolytic. P<0.01 statistical significance of the tendency.

Figure 2

Diagnostic and therapeutic procedures carried out during the hospitalisation. For all variables p<0.01 statistical significance of the tendency.

Figure 3

Harmacological treatment programmed for hospital discharge in percentages. For all variables p<0.01 statistical significance of the tendency.

Figure 4

Pharmacological treatment programmed for hospital discharge in percentages. For all variables p<0.01 statistical significance of the tendency.