[Management of myocardial infarction in Spain in the year 2000. The PRIAMHO II study].
OBJECTIVE
Hospital registries are useful tools to measure the degree of implementation of new treatments and clinical practice guidelines.


METHODS
The hospital registry described here was developed in the prospective PRIAMHO II study, which involved a random selection of Spanish hospitals with a coronary intensive care unit and external quality control. This study investigated patients admitted to the coronary care unit with acute myocardial infarction. Demographic and clinical characteristics were recorded, as well as the management, clinical course and survival after 28 days and one year.


RESULTS
From May 15 to December 15 2000 we included in the registry 6,221 patients from the 58 hospitals that complied with the quality control requirements (71.6% of all participating hospitals). Acute mortality was 9.6%; 28-day and one-year mortality were 11.4% and 16.5%, respectively. Of the patients with ST elevation-myocardial infarction of less than 12 hours' duration, 71.6% were reperfused and 89.3% received fibrinolysis with a median door-to-needle time of 48 minutes. Ejection fraction was measured in 81% of the patients, and 43% were tested for inducible ischemia. About nine-tenths (91%) of the patients were discharged on least one antiplatelet drug, 56% on a beta blocker, 45% on an ACE inhibitor, and 45% on a lipid-lowering agent, with a coefficient of variation between hospitals greater than 25% for the last three drugs.


CONCLUSIONS
The percentage of patients with ST elevation treated with reperfusion should increase, as it probably will thanks to the increasing use of primary angioplasty. The door-to-needle time was longer than the recommended interval. In-hospital risk stratification was good but nonsystematic for the evaluation of ejection fraction, and unsatisfactory for inducible ischemia testing. At discharge the percentages of patients receiving beta blockers, ACE inhibitors and statins were not optimal, and there were wide variations in prescribing practices between hospitals.
Arós
Fernando
F
Area de Cardiología y Críticos. Hospital Txagorritxu. Vitoria. España. aros.borau@euskalnet.net
Cuñat
José
J
Loma-Osorio
Angel
A
Torrado
Elilberto
E
Bosch
Xavier
X
Rodríguez
Juan J
JJ
López Bescós
Lorenzo
L
Ancillo
Pablo
P
Pabón
Pedro
P
Heras
Magda
M
Marrugat
Jaume
J
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D013030:Spain