[Comparison of treatment and prognosis after acute myocardial infarction in two university hospitals in Reykjavik, Iceland 1996.].
BACKGROUND
The treatment of patients after acute myocardial infarction (AMI) is in part related to the available technology at the hospital of admission. In Iceland percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was only performed at Landspítalinn at the time of the research. We compared the treatment and prognosis of patients after AMI in 1996 at the two university hospitals in Reykjavík, Iceland, Landspítalinn (LSP) and Sjúkrahús Reykjavíkur (SHR).


METHODS
We retrospectivly collected informations on all patients admitted with AMI at LSP and SHR in 1996 and compared mortality, morbidity and interventional procedures at one year after admission.


RESULTS
The one-year mortality was 17.7% among patients admitted to LSP compared with 20.8% among patients admitted to SHR (p=0.55). Upon discharge from LSP 82% of patients received aspirin and 68% received a ss-blocker versus 71% and 57% of patients discharged from SHR (p=0.021 and p=0.028 respectively). Conversely 29% of patients were disharged with a calsium-antagonist and 76% with a nitrate from SHR compared with 16% and 51% at LSP (p=0.004 and p<0.001 respectively). There was no diffirence in the use of thrombolytics, angiotensin converting enzyme inhibitors, digoxin, diuretics or antiarrhythmics. Within one year 32% of patients admitted to LSP had undergone PTCA but only 13% of patients admitted to SHR (p<0.001). Further, 10% of patients had undergone CABG within one year at LSP compared with 11% at SHR (p=0.75). On average patients at LSP had a 10 days shorter waiting period from admission to PTCA (p=0.001).


CONCLUSIONS
Despite greater use of PTCA, aspirin and ss-antagonist at LSP compared with SHR there was no significant diffirence in one-year mortality between the hospitals. The greater use of calcium-antagonists and nitrates at discharge among patients discharged from SHR might indicate that they were more symptomatic than patients discharged from LSP. We find the great difference in treatment of patients after AMI according to hospital of admission unacceptable. This problem could possibly be solved by implying clinical guidelines.
Kristjánsson
J M
JM
Landspitali University Hospital, Hringbraut, 101 Reykjaví, Iceland. kandersen@landspitali.is.
Andersen
K
K