MEDICAL-CARE AFTER MYOCARDIAL-INFARCTION - TRENDS OBSERVED IN THE FRENCH MONICA PROJECT BETWEEN 1985 AND 1991

This paper describes the trends observed in the treatment of myocardia l infarction within the three French MONICA registers between 1985 and 1991. Data, collected according to the WHO-MONICA Protocol, relate to the initial care of patients and the treatment they were prescribed. In this study 2974 cases are included. The time delays before hospital ization do not change in spite of an increasing use of mobile emergenc y care units. In all three centers there is a strong progression of th rombolysis, increasing from 12% to 41% in Strasbourg, from 21% to 47% in Toulouse and from 31% to 35% in Lille. Antiplatelet drugs rise from 11% to 76% in Strasbourg, from 39% to 85% in Toulouse andfrom 33% to 76% in Lille. Beta-blockers also progress in the three centers. Prescr iption of anticoagulants, nitrates and antiarrythmics is constant. In contrast calcium blockers are less prescribed. Duration of hospital st ay is much longer in Strasbourg. In Toulouse the resort to coronary an giography (96%) and to angioplasty (51%) is much more frequent than in the two other centers. Similar trends in the three regions reflect th e results of the secondary prevention trials conducted in the last yea rs. Differences concern mainly treatments and procedures that were les s studied before 1991. It will be interesting to study the trends in t he following years in order to estimate the influence of the trials on the homogeneity of practice in the three centers.