Management and two-year prognosis of patients with acute myocardial infarction in a community hospital toward the end of thrombolytic era.
OBJECTIVE
To analyze management, early and long-term prognoses of patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Until now, in Slovakia there have been no relevant data published on prognoses of patients who were treated due to STEMI one or more years ago. We also checked for the adherence to STEMI guidelines at a community hospital.


METHODS
All 112 patients admitted within 24 hours of STEMI to the Faculty Hospital in Bratislava-Petrzalka in 2000-2001 were involved. Data on acute course of STEMI were acquired from medical records. Two years after STEMI patients were asked to complete a questionnaire. Standard statistic methods were used.


RESULTS
Average age of patients was 59.9 +/- 13.3 (mean +/- SD) years. Main prevalent risk factors included smoking (51.8%), diabetes (22.3%), hypercholesterolaemia (54.5%), arterial hypertension (51.8%). Thrombolytic treatment was given to 64.3% of patients; other 25.0% of patients were contraindicated because of their late presentation. Potentially serious complications occurred in 50.9% of patients. Coronarography was performed during the hospitalization in 11.6% of patients and within next 2 years in 19.2% of patients. In-hospital mortality was 11.6%, two-year mortality was 6.1%.


CONCLUSIONS
High prevalence of risk factors, late presentation of patients together with low accessibility to early PCI were responsible for the high amount of patients with complicated STEMI course despite good adherence to clinical guidelines. We expect much better prognoses in patients treated with primary PCI since the management has changed in Slovakia. Long-term prognoses of patients discharged after uncomplicated STEMI and treated with early thrombolysis were optimistic (Tab. 5, Fig. 1, Ref. 17).
Kaluzay
J
J
4th Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia. kaluzay@yahoo.com
Remisova
S
S
Pontuch
P
P
D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D015912:Thrombolytic Therapy