Variability in management and short- and mid-term prognosis of myocardial infarction in Spain: The PRIAMHO study

Background and purpose. The paucity of data on myocardial infarction manage ment and results in Spain lead to the design of the PRIAMHO study (Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario [Acute Myocardial I nfarction Hospital Registration Project]) which developed standard methods to collect information on the management of patients with such a condition and their characteristics. The variability results among hospitals in myoca rdial infarction management and in one-year mortality are presented. Methods. A cohort study with a one-year followup was designed to register a ll patients diagnosed with acute myocardial infarction discharged from 24 S panish hospitals that completed all the requisites to participate. The demo graphic and clinical characteristics of the patients, their management duri ng the coronary care unit stage, and the outcome and complications mere pro spectively registered. Standard definitions for diagnosis were used. Confid entiality regarding patient identity and participating centers was guarante ed. Results. 5,242 (77.6%) of the 6,756 patients with myocardial infarction adm itted in the 24 participating hospitals mere registered in the coronary car e units. Half of the centers had an on-site hemodynamic laboratory and in s even coronary surgery. The delay between symptom-onset and emergency room a dmission was 2 hours. Acute pulmonary edema or cardiogenic shock was develo ped by 16.6% of patients and 41.8% received thrombolysis. Mean time delay b etween symptom-onset and thrombolysis was 3 hours. A large variability in t he use of betablockers, thrombolysis, echocardiography, coronary catheteriz ation angiography and invasive revascularization was observed among hospita ls. Mortality in the coronary care unit was 10.9% and increased to 14.0% at 28 days and to 18.5% at one year with considerable variation among hospita ls. Four hospitals showed higher mortality among their patients, independen tly from the proportion of diabetis, hypertension, women, anterior location of myocardial infarction, non-Q-wave infarction, age and severity. Conclusions. The results of this study show that early and mid-term mortali ty from myocardial infarction is still high in Spain in the reperfusion era , and that a considerable variability in management and outcome exists amon g Spanish hospitals, which is not explained by the different case-mix among them.