TRENDS IN CORONARY HEART-DISEASE MORBIDITY AND MORTALITY AND ACUTE CORONARY-CARE AND CASE-FATALITY FROM 1985-1989 IN SOUTHERN GERMANY AND SOUTH-WESTERN FRANCE - RESULTS FROM THE MONICA PROJECTS IN AUGSBURG ANDTOULOUSE

Background Although it has been shown that coronary heart disease mort ality rates are decreasing in industrialized countries, little is know n about time trends in coronary heart disease incidence. Further, alth ough a number of randomized clinical trials have shown that percutaneo us transluminal coronary angioplasty and thrombolysis improve survival of acute myocardial infarction patients, it is not known if widesprea d use of these therapeutic procedures has contributed to a decrease in in-hospital case fatality an a population basis. Methods The change o ver time of coronary heart disease attack, incidence and mortality rat es was assessed in men and women (35 to 63 years) using data collected between 1985 and 1989 by the Augsburg (Germany) and Toulouse (France) MONICA Centres. Acute coronary care and 28-day case fatality for hosp italized 24-h survivors were also assessed. Results Men and women from Augsburg had higher age-standarized attack, incidence and mortality r ates than their Toulouse counterparts. In both centres, attack, incide nce and mortality rates declined in men, but increased in women. Patie nts in Toulouse received more percutaneous transluminal coronary angio plasty and thrombolysis and had lower 28-day case fatality than patien ts in Augsburg. The therapeutic procedures, percutaneous transluminal coronary angioplasty and thrombolysis increased in both centres; howev er, only in Toulouse was this increase associated with a decrease (non significant) in 28-day hospital case fatality. Conclusion The increas e in morbidity and mortality rates of coronary heart disease in women stresses the need for preventive measures in this group. The absence o f a favourable effect of acute coronary carl on 28-day fatality for ho spitalized 24-h survivors in the Augsburg centre will be further inves tigated.