MYOCARDIAL-INFARCTION CASE-FATALITY GRADIENT IN 3 FRENCH REGIONS - THE INFLUENCE OF ACUTE CORONARY-CARE

The objective of this study was to evaluate the influence of acute cor onary care on the myocardial infarction (MI) case-fatality gradient ob served in three French regions. In 1989, a total of 813 hospitalized e vents of premature Mt, occurring in men and women aged 25-64, were reg istered in three WHO-MONICA sites established in Lille (North of Franc e), Strasbourg (East of France) and Toulouse (South of France). The ca se-fatality rates observed 28 days after the onset of the RAI, were 30 .6% in Lille, 17.5% in Strasbourg and 9.9% in Toulouse (P < 0.0001). W e compared the management of events and the use of cardiovascular ther apies in these centres before admission to hospital, during the stay a nd on discharge from hospital. Differences were observed between the t hree centres in the use of medical treatments: in Strasbourg, aspirin and antiplatelet agents were prescribed 15% less frequently, (P < 0.00 01) while diuretics were prescribed twice as often as in Toulouse (P < 0.0001). Thrombolytic agents (P < 0.01) and invasive techniques (coro nary angiography, coronary angioplasty and coronary bypass surgery) (P < 0.0001) were more widely used in Toulouse compared with the two oth er centres. Lille might have a higher rate of coronary case fatality t han Strasbourg and Toulouse because of a series of cumulative characte ristics. The disease presented in a more serious form: more frequent e lectrocardiographic changes in anterior leads (P < 0.02), higher perce ntage of use of inotropic drugs in association with diuretic agents (P < 0.04), and longer duration of stay in intensive care units (P < 0.0 001). However, when case-fatality rates were adjusted for all these va riables in a multivariate model, the rate remained significantly highe r in Lille than in the two other centres (P < 0.0001), as suggested by the odds ratio (3.27, 95% confidence interval: 1.69-6.32). In conclus ion, the influence of acute coronary care on the MI case-fatality grad ient observed between the North and South of France is very weak.