Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986-92: the FINMONICA Myocardial Infarction Register study

Objectives. To investigate changes in the medical treatment of patients wit h myocardial infarction and the trends in revascularization procedures in F inland. Design. A population-based myocardial infarction (MI) register study. Setting. Populations, aged 25-64 years, of the three geographical areas of Finland, provinces of North Karelia and Kuopio in eastern Finland and the T urku-Loimaa area in south-western Finland. Main outcome measures. Medical treatment administered prior to the coronary event, during the hospitalization and at discharge from hospital to all pa tients hospitalized due to suspected myocardial infarction and all CAD deat hs occurring during three separate 4-month periods in 1986, 1989 and 1992. Data on coronary bypass surgery and percutaneous coronary angioplasty in th e study areas for 1986-92. Results. The most marked change in the medical treatment of hospitalized my ocardial infarction patients was the significant increase in the use of thr ombolytic treatment (5% of patients in 1986 and 24% in 1992, P < 0.001 for trend). The use of antiplatelet agents increased from 1986 to 1992 prior to the coronary event, during the hospitalization and at discharge. The use o f beta-blockers and intravenous nitrates increased and the use of calcium-c hannel blockers declined significantly in hospitalized patients during the study period. Hospitalized male myocardial infarction patients were treated more often with beta-blockers, nitrates, antiplatelet agents and thromboly tic agents than female patients, suggesting less intensive medical treatmen t in women. Conclusion. The results of the large clinical trials regarding the medical treatment of myocardial infarction patients were adopted in the clinical pr actice rapidly and the treatment of myocardial infarction patients and the number of revascularization procedures changed markedly from 1986 to 1992 i n Finland. These changes may in part explain the favourable changes in mort ality from CAD in Finland.