Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986-92: the FINMONICA Myocardial Infarction Register Study.
OBJECTIVE
To investigate changes in the medical treatment of patients with myocardial infarction and the trends in revascularization procedures in Finland.


METHODS
A population-based myocardial infarction (MI) register study.


METHODS
Populations, aged 25-64 years, of the three geographical areas of Finland, provinces of North Karelia and Kuopio in eastern Finland and the Turku-Loimaa area in south-western Finland.


METHODS
Medical treatment administered prior to the coronary event, during the hospitalization and at discharge from hospital to all patients hospitalized due to suspected myocardial infarction and all CAD deaths occurring during three separate 4-month periods in 1986, 1989 and 1992. Data on coronary bypass surgery and percutaneous coronary angioplasty in the study areas for 1986-92.


RESULTS
The most marked change in the medical treatment of hospitalized myocardial infarction patients was the significant increase in the use of thrombolytic treatment (5% of patients in 1986 and 24% in 1992, P < 0.001 for trend). The use of antiplatelet agents increased from 1986 to 1992 prior to the coronary event, during the hospitalization and at discharge. The use of beta-blockers and intravenous nitrates increased and the use of calcium-channel blockers declined significantly in hospitalized patients during the study period. Hospitalized male myocardial infarction patients were treated more often with beta-blockers, nitrates, antiplatelet agents and thrombolytic agents than female patients, suggesting less intensive medical treatment in women.


CONCLUSIONS
The results of the large clinical trials regarding the medical treatment of myocardial infarction patients were adopted in the clinical practice rapidly and the treatment of myocardial infarction patients and the number of revascularization procedures changed markedly from 1986 to 1992 in Finland. These changes may in part explain the favourable changes in mortality from CAD in Finland.
Miettinen
H
H
Department of Medicine, Kuopio University Hospital, Finland. heikki.miettinen@uku.fi
Salomaa
V
V
Ketonen
M
M
Niemelä
M
M
Immonen-Räihä
P
P
Mähönen
M
M
D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012042:Registries; D012737:Sex Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents