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European Heart Journal 1997 18(9):1438-1446;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

The 60 Minutes Myocardial Infarction Project

Treatment and clinical outcome of patients with acute myocardial infarction in Germany

J. Rustige*,, R. Schiele*, U. Burczyk*, A. Koch{dagger}, M. Gottwik, K. L. Neuhaus||, U. Tebbe{ddagger}, R. Uebis§ and J. Senges*

*Herzzentrum Ludwigshafen Germany
{dagger}Zentrum zur Methodischen Betreuung von Therapiestudien (ZMBT) Heidelberg Germany
¶Klinikum Nürnberg Süd; for the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) Germany
||Städtische Kliniken Kassel Germany
{ddagger}Klinikum Lippe-Detmold Germany
§Klinikum Aschaffenburg Germany

revised 17 March 1997; accepted 21 March 1997.

Correspondence: Jörg Rustige, MD, Herzzentrum Ludwigshafen. Department of Cardiology, Bremserstr, 79, D-67063 Ludwigshafen, Germany

Abstract

AIMS: To describe patient characteristics, pre-hospital delay, treatment, complications and outcome in patients with acute myocardial infarction admitted to hospitals in Germany.

METHODS AND RESULTS: The study was of prospective observational multicentre design. Those involved were consecutive patients with acute Q-wave myocardial infarction admitted within 96 h of onset of symptoms to 136 German hospitals between July 1992 and September 1994 (n=14980, median age 66 (quartiles 57, 74) years, 68% male, 48% anterior wall infarction). Median pre-hospital delay was 170 (90, 475) min, with 17% arriving within the first hour and 61% within 4 h of onset of symptoms. The following patient groups had a short pre-hospital delay: males, those aged less than 65 years, those admitted at night or the weekend, those with a previous myocardial infarction, those in need of cardiopulmonary resuscitation, and those with a diagnostic first ECG. The first ECG was diagnostic in 67·6% of cases. Reperfusion therapy was used in 53%, with thrombolytic therapy in 51·6%. Median time from admission to initiation of treatment was 30 (20, 55) min. Respective rates of treatment with aspirin, nitrates, and beta-blockers were 81%, 83% and 16%. Major complications were cerebral bleeding (0·4%), bleeding requiring transfusions (0·9%), left ventricular rupture (0·6%) and anaphylactic shock (0·1%). Median hospital stay was 20 (13, 26) days. In-hospital death rate was 17·2%. Increased hospital mortality was observed with female gender, an unknown or long pre-hospital delay, a diagnostic first ECG, anterior wall infarction, trauma or major operation within the last 14 days, renal insufficiency and malignoma.

CONCLUSIONS: ‘Real-life’ hospital mortality is much higher than previously reported in clinical trials. To reduce hospital mortality, the efficacy of thrombolysis should be increased by shortening the pre-hospital delay, and the use of concomitant therapy, especially beta-blockers, should be increased.

Key Words: Acute myocardial infarction • registry • thrombolysis • pre-hospital delay


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