Characteristics, management, and in-hospital mortality of acute myocardialinfarction in the "real world" in France - Data from a large unselected cohort of 2,519 consecutive patients in a French region

Objective - The prospective PRIMA study (Prise en charge de I'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regar dless of age and hospital facilities, in the "real world" in a region in Fr ance. Methods and results - Data were prospectively collected in all patients wit h MI admitted in all hospitals in three departments in the Rhone-Alpes regi on between September 1, 1993 and January 31, 1995. 2,519 patients (68% men; mean +/- SD: 68 +/- 14 years) were included. Time from onset of symptoms t o admission was 6 h in 56% of the patients (median: 4 h 30 min). MI was non -Q wave in 12%. Among Q wave MI, location was anterior in 44%. At admission , Killip class was 1 in 33%. The overall rate of thrombolysis was 36%. It w as significantly higher in men than in women, in younger patients than in o lder patients, in lower Killip classes, in Q wave MI, and when the delay be fore initial medical intervention was < 6 hours. After age-adjustment, ther e was no difference between men and women for thrombolysis rate (odds ratio women/men: 0.92; P = 0.10). During the first 5 days, Killip class worsened in 17%. In-hospital mortality rate was 14%. Multivariate analysis identifi ed age, anterior location, presence of Q waves, and higher Killip classes a s significant predictors of in-hospital mortality. Conclusions - This large unselected cohort revealed that among patients wit h MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.