title: Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012--nationwide AMI-PL database.
abstract: OBJECTIVE
  Nationwide data on acute myocardial infarction (AMI) are available for some Western but not for Central and Eastern European countries. We performed a study on nationwide data of all Polish AMI patients in 2009-2012 to assess incidence, quality of care, and cardiovascular events during 1 year following AMI.
  
  
  METHODS
  The database of the only public, obligatory health insurer in Poland (National Health Fund) together with data from the Central Statistical Office were used. AMI cases were selected based on primary diagnosis ICD-10 codes I21-I22. For years 2009-2012, index hospitalisations (n = 311,813) in a given year and death records were analysed. Additionally, data on hospitalisations, procedures and deaths during 1 year follow-up were obtained for 2009.
  
  
  RESULTS
  Age-adjusted incidence of AMI in Poland in 2009 was 196 cases per 100,000 population (176 per 100,000 were hospitalised), with a decreasing trend over time. The incidence was 2.5 times higher in men than in women. The median age was 63 years in men and 74 years in women. The proportion of ST elevation myocardial infarction (STEMI) decreased from 59% to 48% in 2012, and the proportion of patients receiving invasive treatment increased from 72% to 81%. Age-adjusted case fatality rate was equal in women and men. In 2009, the number of patients with AMI was 75,054 (61% men, 39% women) and 83% of them were treated in cardiology units. Invasive strategy was used in 77% of patients with STEMI and 66% of those with non-STEMI, thrombolysis in 1% and coronary artery bypass grafting in 1.9% of patients. Invasive treatment was used less frequently in women and the elderly patients. When all hospitals where a patient was treated until the final discharge were taken into account, in-hospital mortality was 10.5%. The lowest in-hospital mortality was noted among patients treated invasively (6.3%). The total number of readmissions within 1 year following AMI was 84,718, of which 61.9% were due to cardiovascular causes. The most common causes were stable coronary artery disease (27%), heart failure (7.9%), recurrent infarction (7.0%), and unstable angina (6.8%). Within 1 year after AMI, only 22% of patients participated in a cardiac rehabilitation programme. Total 1-year mortality was 19.4% (invasive treatment 12.3%, non-invasive treatment 38.0%).
  
  
  CONCLUSIONS
  Standards of care and early outcomes in AMI in Poland are similar to Western countries. The major cause of higher mortality due to AMI in the Polish population is a high incidence of AMI, indicating a need for intensification of primary prevention programmes. Secondary prevention is also underused, especially in the field of cardiac rehabilitation.
authors.affiliation: 3rd Chair and Department of Cardiology, Department of Cardiovascular Diseases, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland. marek.gierlotka@sccs.pl.
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
authors.forename: Bogdan
authors.initials: B
authors.lastname: Wojtyniak
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.forename: Jakub
authors.initials: J
authors.lastname: Stokwiszewski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Adam
authors.initials: A
authors.lastname: Kozierkiewicz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Wierucki
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Chlebus
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.forename: Mirosław
authors.initials: M
authors.lastname: Wysocki
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D011044:Poland / Q000453:epidemiology; D016896:Treatment Outcome