Management of patients treated for myocardial infarction in different regions of Hungary and patient survival for 10 years / Szívinfarktus miatt kezelt betegek ellátása Magyarország különbözo régióiban és a betegek 10 éves túlélése.

Összefoglaló. Elozmény: A szívinfarktus miatt kezelt betegek ellátásának regionális adataira és a betegek hosszú távú kórlefolyására vonatkozó hazai kutatás eddig nem történt. Célkituzés: A vizsgálat célja a Magyar Infarktus Regiszter pilotidoszakában rögzített betegeknél az ellátás és a 10 éves túlélés elemzése a magyarországi nagyrégiókban. Módszer: A Magyar Infarktus Regiszter (késobbi neve: Nemzeti Szívinfarktus Regiszter) 2010. január 1. és 2013. december 31. között a centrumok önkéntes részvételével 23 142 beteg adatait rögzítette, akik írásban hozzájárultak egészségügyi és klinikai adataik kezeléséhez. Az adatgyujtés a Kutatásetikai Bizottság engedélyével rendelkezett. A vizsgált populációban 12 104, ST-elevációval járó myocardialis infarctuson (STEMI) és 10 768, ST-elevációval nem járó myocardialis infarctuson (NSTEMI) átesett beteg szerepelt. A feldolgozott adatok 128 220 betegévre vonatkoznak, amelyeket nagyrégiók szerint (Nyugat-, Közép- és Kelet-Magyarország) hasonlítottunk össze. Eredmények: A STEMI-betegek 78,4%-ánál, az NSTEMI-betegek 51,6%-ánál történt katéteres érmegnyitás (PCI). NSTEMI esetén a Közép-Magyarország és Nyugat-Magyarország régiókban a beavatkozás gyakoribb volt, mint a Kelet-Magyarország régióban (p<0,01). Az utánkövetés során a PCI a Nyugat-Magyarország régióban, a revascularisatiós szívmutét (CABG) a Nyugat-Magyarország és a Kelet-Magyarország régióban szignifikánsan gyakoribb volt, mint a Közép-Magyarország régióban (p<0,01). A STEMI-betegek között a 10 év alatt a férfiak 49,2%-a, a nok 46,6%-a halt meg, az NSTEMI-csoportban 63%, illetve 57,6%. Az akut szakban elvégzett PCI mindkét betegcsoportban, nemben, az utánkövetés minden idopontjában és a vizsgált régiókban csökkentette a halálozást (p<0,01). A STEMI-betegek esetén a túlélés a régiók között nem különbözött (p = 0,72), míg az NSTEMI után a 10 éves túlélés a Nyugat-Magyarország régióban jobb volt (p<0,01). Következtetés: A magyarországi nagyrégiók között az infarktusos betegek ellátásában és prognózisában regionális különbségek vannak. Orv Hetil. 2021; 162(36): 1438-1450. HISTORY: Regional data on patients' care for myocardial infarction and the long-term follow up of patients have not yet been studied in Hungary. OBJECTIVE: The study aims to analyze the care and 10-year survival of patients recorded during the Hungarian Myocardial Infarction Registry's pilot period in large regions of Hungary. METHOD: Between Jan 1, 2010 and Dec 31, 2013, the Hungarian Myocardial Infarction Registry recorded data on 23 142 patients with voluntary participation. The Research Ethics Committee approved the program. The study included 12 104 patients with ST-elevation myocardial infarction (STEMI) and 10 768 patients with non-ST-elevation myocardial infarction (NSTEMI). The data processed refer to 128 220 patient years based on large regions (West, Central and East Hungary). RESULTS: Percutaneous coronary intervention occurred in 78.4% of STEMI patients and 51.6% of NSTEMI patients. In the NSTEMI group, percutaneous coronary interventions (PCIs) in the Central-Hungary and West-Hungary regions were significantly more common than in the East-Hungary region (p<0.01). During follow-up, PCI in the West-Hungary region, revascularization surgery in the West-Hungary and East-Hungary regions were significantly more common than in the Central-Hungary region (p<0.01). Among STEMI patients, 49.2% of men and 46.6% of women died within 10 years, while in the NSTEMI group 63% and 57.6%, respectively. PCI reduced mortality in both patient groups, sex, at all times of follow-up and in the regions studied (p<0.01). As for STEMI patients, survival was similar in all regions (p = 0.72), while after NSTEMI, 10-year survival in the West-Hungary region was better (p<0.01). CONCLUSION: There are regional differences in the care and prognosis of patients with myocardial infarction. Orv Hetil. 2021; 162(36): 1438-1450.

Does Gender Have Prognostic Value Among Patients with Myocardial Infarction? Analysis of the Data from the Hungarian Myocardial Infarction Registry.

Background: The authors analyzed data from the Hungarian Myocardial Infarction Registry (HUMIR) to examine the potential impact of gender on the treatment and 30-day and 1-year mortality of patients with myocardial infarction (MI). Materials and Methods: The National Registry of Myocardial Infarction included 42,953 patients between January 1, 2013 and December 31, 2016; 19,875 of whom were diagnosed with ST-elevation myocardial infarction (STEMI) and 23,078 with non-ST-elevation myocardial infarction (NSTEMI). The proportion of women was 39% and 41.9% in the two groups, respectively. Logistic regression analysis was performed adjusting for age, the year and month of hospital admission, smoking, as well as for five concomitant diseases and anamnestic data. We found that the odds ratio (OR) of performing percutaneous coronary intervention (PCI) was influenced by age, the year of treatment, prior stroke, and peripheral artery disease (PAD) in both patient groups. Results: Gender had an impact on treatment in both cases; women had significantly fewer PCIs (OR = 0.86 confidence interval [95% CI: 0.77-0.95] in the STEMI group, OR = 0.75 [95% CI: 0.70-0.82] in the NSTEMI group). Age and PCI, PAD, and diabetes mellitus proved to be prognostic factors for 30-day and 1-year mortality in both groups. In the STEMI group, hypertension proved to be of prognostic value for both 30-day and 1-year mortality, whereas prior MI, stroke, and smoking only affected 1-year mortality. Similarly, in the NSTEMI group, prior stroke was also of prognostic value for 30-day and 1-year mortality, whereas prior MI, hypertension and smoking were only associated with 1-year mortality. Conclusions: The independent prognostic value of gender could not be proven for any of the MI types or follow-up periods. In conclusion, gender influenced the treatment of patients with MI but had no significant impact on prognosis in itself.

Comparison of Platelet Function Guided Versus Unguided Treatment With P2Y12 Inhibitors in Patients With Acute Myocardial Infarction (from the Hungarian Myocardial Infarction Registry).

Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96% vs PFT guided: 85%, p <0.001). In the PFT-guided group, 19% of patients had HPRoC and 77% of them were switched to prasugrel. According to the adjusted analysis, all-cause mortality at 1 year was significantly lower in the PFT-guided compared with the unguided group (hazard ratio 0.57 [95% confidence interval 0.43 to 0.77], p <0.001). Although prasugrel treatment was not associated with lower all-cause mortality in the overall cohort, patients with HPRoC who switched to prasugrel had significantly lower mortality when compared with those continuing clopidogrel (hazard ratio 0.33 [95% confidence interval 0.12 to 0.92], p <0.05). In conclusion, in patients with AMI, PFT-guided treatment with a high rate of switchover to prasugrel was associated with a lower risk of mortality. Prasugrel was a predictor of lower mortality in patients with HPRoC but not in the overall cohort of AMI.

[Clinical presentation and hospital outcome of patients with ST-elevation myocardial infarction -- Hungarian Myocardial Infarction Registry data]. / ST-elevációval járó myocardialis infarctus miatt kezelt betegek klinikai jellemzoi és kórházi prognózisa - Magyarországi Infarctus Regiszter.

INTRODUCTION: There are only very few data on gender differences in patients with ST-elevation myocardial infarction. AIM: To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. PATIENTS AND METHODS: Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. RESULTS: Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p<0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p<0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p<0.001). CONCLUSIONS: At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.

[Myocardial Infarction Registry conducted forty years ago in Hungary]. / Infarktus Regiszter 40 év távlatából: 1971-2011.

AIMS: Authors summarize the most important findings of the Myocardial Infarction Community Registry conducted in Hungary 40 years ago. The report is important because data are not available on the internet through literature search and since 40 years such study has not been performed. The incidence of acute myocardial infarction in subjects older than 20 years of age in the population of South Pest with 400 000 inhabitants in 1971 was 50.9/10 000 in men and 23.7/10 000 in women. The mortality rate of myocardial infarction during the first year was 56.2% in men and 60.7% in women. Two-third of the first-year death occurred in the first 24 hours and 85% of it in the prehospital period. Only 6% of the patients with acute myocardial infarction were admitted and treated in Coronary Care Units. Based on the data of the Myocardial Infarction Community Registry, measures were introduced which decreased the 28-days mortality rate at the population level. CONCLUSIONS: Authors emphasize that in the last decades the diagnosis and treatment of myocardial infarction has substantially changed which makes it necessary to re-evaluate by epidemiologic methods the natural history, incidence and mortality of acute myocardial infarction in Hungary.

Impact of hyperglycemia on perioperative mortality after coronary artery bypass graft surgery.

OBJECTIVE: The roles of perioperative hyperglycemia and diabetes in the risk stratification of patients undergoing coronary artery bypass graft surgery are unclear. The aim of this study is to explore the influence of perioperative hyperglycemia on postoperative mortality. METHOD: A prospective, observational study of 5050 patients undergoing cardiopulmonary bypass for coronary artery bypass graft surgery at 70 international centers was conducted, with 7500 measured variables per patient and outcomes adjudicated centrally. Postoperative blood glucose levels measured from the day of surgery to postoperative day 3 were available for 4799 patients. Multivariable logistic regression was used to determine the association of hyperglycemia with hospital mortality. RESULTS: A total of 164 patients died during hospitalization (3.2%). Mortality was significantly higher in the diabetic population compared with the nondiabetic population (4.2% vs 2.9%; P = .02). In nondiabetic patients, maximum postoperative blood glucose between 250 and 300 mg/dL (adjusted odds ratio, 2.56; 95% confidence interval, 1.18-5.57; P = .02) and maximum blood glucose of 300 mg/dL or greater (adjusted odds ratio, 2.74; 95% confidence interval, 1.22-6.16; P = .01), compared with maximum blood glucose less than 200 mg/dL, and postoperative insulin treatment (adjusted odds ratio, 2.04; 95% confidence interval, 1.12-3.70), were independent risk factors for an increased risk of in-hospital mortality. In diabetic patients, hyperglycemia was not associated with a higher mortality risk. CONCLUSIONS: Postoperative hyperglycemia is associated with increased in-hospital mortality in nondiabetic patients after coronary artery bypass graft surgery. In diabetic patients, hyperglycemia was not associated with mortality.

[Heart transplantation after corrective surgery of a congenital heart disease. Surgical technical problems]. / Sikeres szívátültetés veleszületett szívhiba korrekciós szívmutéte után. Sebésztechnikai problémák.

Heart transplantation was performed in a 17-year old boy with severe left ventricular failure. Previously a congenital heart disease, tetralogy of Fallot was reconstructed in one and half years old of age. Authors present the different surgical problems complicated this procedure. In Hungary this is the first heart transplantation after a corrective surgical procedure of a complex congenital heart disease.

[Prevention of cardiovascular diseases: collaborative program]. / A szív- es erbetegségek megelozése: prevenciós osszefogás program.

The so-called Program for preventive collaboration model joins the expertise of specialists and GPs and as such allocates for the effective, cost saving, secure screening of individuals with high and intermediate cardiovascular risk and identifying asymptomatic patients within a big population. Based on SCORE risk assessment GPs define their patients cardiovascular risk. In Gottsegen György Institute of Hungarian Cardiology on patients with intermediate or high risk ankle-brachial doppler index, carotis intima media thickness, artery stiffness, microalbuminuria and left ventricular hypertrophy are diagnosed. Based on the results of non-invasive cardiovascular marker tests a mixed score is elaborated. The applicability of the score is then measured for the further risk assessment of individuals with intermediate or high CV risk. The collaboration of GPs and specialists along with the non-invasive cardiological tests are helpful in the early identification of patients with high cardiovascular risk and when making a decision about drug or non-drug treatments.