title: In-hospital case fatality rates for acute myocardial infarction in Romania.
abstract: BACKGROUND
  We describe the clinical characteristics, treatments and in-hospital case-fatality rates in an unselected population of patients admitted for acute myocardial infarction.
  
  
  METHODS
  From January 2000 to June 2007, we tracked consecutive patients who were admitted to 7 tertiary referral and 21 county hospitals in Romania for medical treatment of ST-segment elevation acute myocardial infarction. These patients were enrolled in the Romanian Registry for ST-segment Elevation Myocardial Infarction. For this prospective study, we collected data on demographic characteristics, cardiovascular risk factors, various aspects of treatment for myocardial infarction, and in-hospital death.
  
  
  RESULTS
  The 9186 patients in the study group had a mean age of 63.8 years. The median time from onset of symptoms to thrombolysis was 230 (interquartile range 120-510) minutes. Of the 9186 patients, 4986 (54.3%) had hypertension, 1974 (21.5%) had diabetes mellitus, 3545 (38.6%) had lipid disorders and 4653 (50.7%) were smokers. The in-hospital mortality rate was 12.7% (1170 deaths). The study group consisted of 2893 women and 6293 men. The women were older than the men and had higher rates of hypertension and diabetes mellitus but were less likely to be smokers. A smaller proportion of women than men presented within 2 hours after onset of symptoms (23.1% v. 34.4%, p < 0.001). Smaller proportions of women received thrombolytics (40.8% v. 53.5%, p < 0.001), anticoagulants (93.4% v. 95.2%; p = 0.001), antiplatelet agents (88.3% v. 91.2%, p < 0.001) and primary percutaneous coronary interventions (1.5% v. 2.2%, p = 0.030). The risk of in-hospital death was greater for women, even after adjustment for confounders (odds ratio 1.33, 95% confidence interval 1.13-1.56; p < 0.001).
  
  
  CONCLUSIONS
  The rates of reperfusion therapy for patients with acute myocardial infarction were low, and in-hospital case-fatality rates were high in this study. Excess in-hospital mortality was more pronounced among women.
authors.affiliation: Floreasca Emergency Hospital, Bucharest, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tatu-Chitoiu
authors.forename: Mircea
authors.initials: M
authors.lastname: Cinteza
authors.forename: Maria
authors.initials: M
authors.lastname: Dorobantu
authors.forename: Mariana
authors.initials: M
authors.lastname: Udeanu
authors.forename: Olivia
authors.initials: O
authors.lastname: Manfrini
authors.forename: Carmine
authors.initials: C
authors.lastname: Pizzi
authors.forename: Marius
authors.initials: M
authors.lastname: Vintila
authors.forename: Dominic D
authors.initials: DD
authors.lastname: Ionescu
authors.forename: Elvira
authors.initials: E
authors.lastname: Craiu
authors.forename: Daniel
authors.initials: D
authors.lastname: Burghina
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bugiardini
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011787:Quality of Health Care; D012042:Registries; D012383:Romania / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data