[Comparison of the incidence, treatment and prognosis of myocardial infarction in Hungary's differently developed districts]. / A szívinfarktus incidenciája, a betegek ellátásának és prognózisának összehasonlítása Magyarország különbözo fejlettségu járásaiban.

INTRODUCTION: Several international studies have already confirmed the importance of the socioeconomic status of acute myocardial infarction patients in terms of patient care and prognosis. To our knowledge, a nationwide examination of this kind has not yet taken place in Hungary. The investigation of this problem field was made possible by the fact that from January 1, 2014, all healthcare providers must record the data of patients treated with a diagnosis of acute myocardial infarction in the database of the Hungarian Myocardial Infarction Registry (HUMIR). OBJECTIVE: In this study, the authors searched for an answer to whether the complex development index (CDI) in Hungary's 174 districts and 23 capital districts influences the treatment and prognosis of acute myocardial infarction patients. METHOD: Based on the CDI worked out by the Hungarian Central Statistical Office, the authors divided the Hungarian districts into low (CDI_L), medium (CDI_M) and high (CDI_H) CDI groups according to their values. They examined the incidence, hospital treatment and prognosis of acute myocardial infarction in these administrative-territorial units. The HUMIR included 66,253 patients treated by myocardial infarction between 2015 and 2019. Their place of residence could be identified based on the zip code and in which district it was located. In the examined population, 29,101 patients with ST-elevation (STEMI) and 37,152 without ST-elevation (NSTEMI) received treatment for acute myocardial infarction. RESULTS: In the population over 15 years of age, the age-standardized incidence of STEMI was 68.8 per 100,000 inhabitants a year in the CDI_L group and 52.7 per 100,000 inhabitants a year in the CDI_H group. Almost the same values were found in all three CDI subgroups of NSTEMI incidence (69.5 and 67 per 10,000 inhabitants a year). The frequency of percutaneous coronary intervention in the case of STEMI was higher than in NSTEMI, but within the groups, CDI did not influence the performance of this treatment. In the case of STEMI, the rates of patients who underwent percutaneous coronaria intervention in all three CDI subgroups (CDI_L, CDI_M, CDI_H) were 83.5%, 83.7%, 83.5%, while in the case of NSTEMI they were 57.4%, 57.7%, 57.3%. The authors applied a Cox multivariate regression analysis to examine myocardial infarction mortality. The CDI did not affect the 30-day mortality rates in the case of any myocardial infarction: the hazard ratio (HR) values were 0.906 and 0.914 (p = 0.04659; p = 0.04686) in the case of STEMI, while 1.067 and 1.001 (p = 0.16520; p = 0.98933) in the case of NSTEMI. In the case of a STEMI diagnosis, the risk of the 30-364-day and the 1-year mortality in the subgroup of CDI_H was significantly lower (HR = 0.822 and 0.816) than in the subgroup of CDI_L (p = 0.00096 and p = 0.00001). In the case of NSTEMI diagnosis, the authors found a difference in the risk of beyond 1-year mortality by comparing the districts in the subgroup of CDI_L with the districts in CDI_H: in the latter case, the HR of the mortality was 0.876, which was significantly lower (p = 0.00029) than in the subgroup of CDI_L. CONCLUSION: The CDI has independent prognostic significance in determining the late prognosis of acute myocardial infarction patients. Orv Hetil. 2022; 163(47): 1862-1871.

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.

Diurnal and seasonal patterns in the incidence and mortality of acute myocardial infarction in Hungary / A heveny szívinfarktus gyakoriságának és az általa okozott halálozás diurnalis és szezonális jellemzoi Magyarországon.

Összefoglaló. Bevezetés: A heveny szívinfarktus gyakoriságának és halálozásának napi és szezonális ingadozása fontos epidemiológiai adat, régóta kutatás tárgya. Célkituzés: A szívinfarktus gyakoriságának, az általa okozott halálozásnak diurnalis és szezonális vizsgálata nagy esetszámú, válogatás nélküli betegcsoport adatainak elemzésével. Módszer: A szerzok a Nemzeti Szívinfarktus Regiszterben 2014. 01. 01. és 2017. 12. 31. között regisztrált betegek adatait dolgozták fel. Az adatok többváltozós vizsgálatára általánosított additív modelleket használtak. Eredmények: Három év alatt 30 333, ST-elevációval nem járó infarktus (NSTEMI) és 23 667, ST-elevációval járó infarktus (STEMI) miatt kezelt beteg adatait rögzítettük. A betegek utánkövetésének medián értéke 563 nap volt. Szívinfarktusra utaló panasz - mindkét infarktustípus esetén - reggel 7 és 8 óra között jelentkezett a leggyakrabban, NSTEMI esetén este 20 óra körül is találtak egy második gyakorisági csúcsot. A hét napjai a gyakoriság szempontjából szignifikáns eltérést mutattak (p<0,001): hétfon magasabb, hétvégén lényegesen alacsonyabb incidenciát találtunk. Az éven belüli mintázat mindkét nemi, életkori és infarktustípus szerinti csoportban konzisztens: tavasszal a legmagasabb, nyáron a legalacsonyabb az incidencia (p<0,001). Az incidencia munkaszüneti napokon alacsonyabb volt (p = 0,0053 STEMI-nél, p<0,001 NSTEMI-nél). A halálozás többszempontos analízise azt igazolta, hogy a hét napjai itt is eltértek, hétvégén magasabb halálozás igazolódott (p<0,001). A munkaszüneti napoknak ugyanakkor nem volt szignifikáns hatásuk a halálozásra (p = 0,4542), és az évszakok halálozási adatai sem különböztek (p = 0,0677). Következtetés: A szívinfarktus gyakrabban fordult elo hétfon, a reggeli órákban és az évszakok esetén tavasszal. A halálozás hétvégén nagyobb volt, mint munkanapokon. Orv Hetil. 2021; 162(14): 555-560. INTRODUCTION: Daily and seasonal variation of the incidence and mortality of acute myocardial infarction has long been the subject of research. OBJECTIVE: Investigation of the diurnal and seasonal pattern of the incidence and mortality of myocardial infarction by analyzing data from a large number of consecutive patients. METHOD: The authors processed the data of patients registered in the Hungarian Myocardial Infarction Registry between 01. 01. 2014 and 31. 12. 2017. Generalized additive models were used for the multivariate investigation of the data. RESULTS: 30 333 patients treated for non-ST elevation myocardial infarction (NSTEMI) and 23 667 patients with ST elevation myocardial infarction (STEMI) were recorded. The median follow-up was 563 days. Patients' complaints most commonly occurred between 7:00 and 8:00 a.m. for both types of infarction with a secondary peak at 20:00 p.m. for NSTEMI. The days of week were significantly different (p<0.001) with a higher incidence on Monday, and lower at the weekend. The seasonal pattern was consistent in every age and sex group and according to the type of infarction: incidence was the highest in spring and the lowest in summer (p<0.001). The incidence was lower on public holidays (p = 0.0053 for STEMI, p<0.001 for NSTEMI). Multivariate analysis of mortality revealed that the days of week are significantly different here as well (p<0.001) with a higher mortality at the weekends. The effect of public holidays was non-significant (p = 0.4542) as was seasonality (p = 0.0677) in mortality. CONCLUSION: Myocardial infarction occurs more often in the morning hours, on Monday, and - as far as seasonal variation - in spring. The mortality at the end of the week is greater than on working days. Orv Hetil. 2021; 162(14): 555-560.

Quality assurance of national internet-based patient register data: Experiences during the operation of the Hungarian Myocardial Infarction Registry, 2010­2020 / Internetalapú, országos betegségregiszter adatainak minoségbiztosítása: Tapasztalatok a Nemzeti Szívinfarktus Regiszter muködtetése során, 2010­2020

Összefoglaló. Bevezetés: A Nemzeti Szívinfarktus Regiszterben 111 788 beteg 122 351 infarktusos eseményéhez kapcsolódó 145 292 kezelés adatai szerepelnek. Módszer: A rögzített adatokat az üzemeltetok folyamatosan kontrollálják, bemutatják azokat a minoségbiztosítási módszereket, amelyekkel az adatbázis teljességét és megfeleloségét biztosítják. Az online informatikai rendszerben az adatbevitel során 119 automatikus ellenorzési algoritmust muködtetnek. Az automatikus ellenorzési algoritmussal nem kezelheto adatok ellenorzését 5 részállású, egészségügyi képzettségu kontroller és 2 foállású munkatárs végzi. A regiszter muködése során folyamatosan fejlesztették az ellenorzés módszereit, ennek során 2018-tól a kontrollerek által ellenorzött adatlapok utóellenorzésére is sor kerül. Az utóellenorzés során a már ellenorzött adatlapok 2,4%-ában további javításra volt szükség. Eredmények: Az utóellenorzés eredménye, hogy a kontrolleri munkát hatékonyabbá sikerült tenni, mivel egyre kevesebb az utóellenorzés során hibásnak talált adatlapok száma. Megvizsgálták, hogy az adatlap kérdéseire milyen arányban kaptak értékelheto választ. Az értékelheto válaszok aránya a legtöbb esetben meghaladta a 90%-ot, azonban a panaszok kezdetének ideje az adatlapok 39%-ában volt megadva, míg a dohányzási szokásokkal kapcsolatos válasz az esetek 59%-ában volt megfelelo. Megbeszélés: A szerzok rámutatnak arra, hogy a Nemzeti Egészségbiztosítási Alapkezelo és a Nemzeti Szívinfarktus Regiszter adatbázisának folyamatos egyeztetése hozzájárul a regisztráció teljességének biztosításához, lehetové teszi a betegek állapotának hosszú távú követését. Miután a program kötelezo jelleguvé vált 2014. 01. 01-jén, az elso évben a szívinfarktus-diagnózissal finanszírozott betegek kétharmada (67%) szerepelt a regiszter adatbázisában; ez az arány a 2017-2019-es években meghaladta a 90%-ot (91,7-93,6-91,3%). Következtetés: Vizsgálatukból a szerzok azt a következtetést vonják le, hogy a betegségregiszter muködése során szükséges az adatok teljességének és megfeleloségének folyamatos ellenorzése. A regiszter adatbázisának 90% feletti teljessége az ellátórendszer minoségi paramétereinek folyamatos követését teszi lehetové. Orv Hetil. 2021; 162(2): 61-68. INTRODUCTION: The Hungarian Myocardial Infarction Registry contains data on 145 592 treatments related to the 111 788 patients and the 122 351 myocardial infarctions. METHOD: The recorded information is continuously monitored, and the quality assurance methods used to ensure the completeness and adequacy of the database are presented. In the online IT system, 119 automatic verification algorithms are operated during data entry. Data that cannot be handled by the automated verification algorithm is checked by five part-time health-qualified controllers and two full-time employees. During the operation of the register, the control methods were continuously developed, during which the data sheets checked by the controllers will be post-checked from 2018 onwards. During the post-checked process, 2.4% of the datasheets required further correction. RESULTS: The number of data sheets found to be incorrect during the post-audit was decreasing. The authors examined the proportion of evaluable answers to the questionnaire. The rate of evaluable responses was over 90% in most cases; however, the time of the onset of symptoms was given in 39% of the datasheets, while the answer to smoking habits was adequate in 59% of cases. DISCUSSION: The authors point out that the continuous consultation of the database of the National Health Fund Management Centre and the Hungarian Myocardial Infarction Registry contributes to ensuring the completeness of registration, enabling long-term monitoring of the condition of patients. In the first year of the mandatory period of the program, two-thirds (67%) of patients treated with a diagnosis of myocardial infarction were included in the registry database, and this proportion exceeded 90% in the years 2017-2019 (91.7-93.6-91.3%). CONCLUSION: The study of the authors concludes that the completeness and adequacy of the data need to be constantly monitored during the operation of the patient registry. The integrity of the register database above 90% enables the continuous monitoring of the quality parameters of the system. Orv Hetil. 2021; 162(2): 61-68.

Short- and long-term prognostic significance of previous recanalization interventions in patients treated for myocardial infarction / A kórelozményben szereplo revascularisatiós mutét rövid és hosszú távú prognosztikai jelentosége szívinfarktus miatt kezelt betegekben.

Összefoglaló. Bevezetés: A szívinfarktust megelozo revascularisatiós beavatkozások prognosztikai jelentoségével kapcsolatban kevés elemzés ismeretes, hazai adatokat eddig nem közöltek. Célkituzés: A szerzok a Nemzeti Szívinfarktus Regiszter adatait felhasználva elemezték a koszorúér-revascularisatiós szívmutétet (CABG) túlélt betegek prognózisát heveny szívinfarktusban. Módszer: Az adatbázisban 2014. 01. 01. és 2017. 12. 31. között 55 599 beteg klinikai és kezelési adatait rögzítették: 23 437 betegnél (42,2%) ST-elevációval járó infarktus (STEMI), 32 162 betegnél (57,8%) ST-elevációval nem járó infarktus (NSTEMI) miatt került sor a kórházi kezelésre. Vizsgáltuk a CABG után fellépo infarktus miatt kezelt betegek klinikai adatait és prognózisát, amelyeket azon betegek adataival hasonlítottunk össze, akiknél nem szerepelt szívmutét a kórelozményben (kontrollcsoport). Eredmények: A betegek többsége mindkét infarktustípusban férfi volt (62%, illetve 59%). Az indexinfarktust megelozoen a betegek 5,33%-ánál (n = 2965) történt CABG, amely az NSTEMI-betegeknél volt gyakoribb (n = 2357; 7,3%). A CABG-csoportba tartozó betegek idosebbek voltak, esetükben több társbetegséget (magas vérnyomás, diabetes mellitus, perifériás érbetegség) rögzítettek. Az indexinfarktus esetén a katéteres koszorúér-intervenció a kontrollcsoport STEMI-betegeiben gyakoribb volt a CABG-csoporthoz viszonyítva (84% vs. 71%). Az utánkövetés 12 hónapja során a betegek 4,7-12,2%-ában újabb infarktus, 13,7-17,3%-ában újabb katéteres koszorúér-intervenció történt. Az utánkövetés alatt a CABG-csoportban magasabbnak találtuk a halálozást. A halálozást befolyásoló tényezok hatásának korrigálására Cox-féle regressziós analízist, illetve 'propensity score matching' módszert alkalmaztunk. Mindkét módszerrel történt elemzés azt mutatta, hogy a kórelozményben szereplo koszorúér-revascularisatiós mutét nem befolyásolta a túlélést. Amennyiben a beteg kórelozményében szerepelt a koszorúérmutét, az indexinfarktus nagyobb eséllyel volt NSTEMI, mint STEMI (HR: 1,612; CI 1,464-1,774; p<0,001). Következtetés: A kórelozményben szereplo koszorúér-revascularisatiós mutét nem befolyásolta a szívinfarktus miatt kezelt betegek életkilátásait. Orv Hetil. 2021; 162(5): 177-184. INTRODUCTION: Little analysis is known about the prognostic significance of revascularization interventions before myocardial infarction; no domestic data have been reported so far. METHOD: The authors use data from the Hungarian Myocardial Infarction Registry to analyze the prognosis of patients with acute myocardial infarction who had previous coronary artery bypass grafting (CABG). Between 01. 01. 2014. and 31. 12. 2017, 55 599 patients were recorded in the Registry: 23 437 patients (42.2%) had ST-elevation infarction (STEMI) and 31 162 patients (57.8%) had non-ST-elevation infarction (NSTEMI). The clinical data and prognosis of patients treated for infarction after CABG were compared with those of patients without a CABG history. RESULTS: The majority of patients were male (59% and 60%, respectively). Prior to index infarction, CABG occurred in 5.33% of patients (n = 2965), which was more common in NSTEMI (n = 2357; 7.3%). The CABG patients were older and had more comorbidities (hypertension, diabetes mellitus, peripheral vascular disease). For index infarction, percutaneous coronary intervention was more common in STEMI patients in the control group compared to CABG (84% vs. 71%). At 12 months of follow-up, 4.7-12.2% of patients had reinfarction, and 13.7-17.3% had another percutaneous coronary intervention. During the full follow-up, the CABG group had higher mortality. Cox regression analysis and propensity score matching were used to correct for the effect of other factors influencing mortality. Both analyses showed CABG did not affect survival. In the CABG group, the index infarction was more likely to be NSTEMI than STEMI (HR: 1.612; CI 1.464-1.774; p<0.001). CONCLUSION: The history of CABG does not affect the life expectancy of patients treated for an acute myocardial infarction. Orv Hetil. 2021; 162(5): 177-184.

[Emergency care of patients with myocardial infarction: from the onset of symptoms until opening the vessel]. / Szívinfarktus miatt kezelt betegek sürgosségi ellátása: a panasz kezdetétol az ér megnyitásáig.

Introduction and aim: The authors analyse emergency care data for 6878 patients treated for acute myocardial infarction (AMI) using data from the Hungarian Myocardial Infarction Registry (HUMIR) and the National Ambulance Service (NAS). Method: Patients received treatment between 01/01/2017 and 31/12/2018, and all patients underwent percutaneous coronary intervention (PCI): 47.5% of patients had ST-elevation myocardial infarction (STEMI) and 3614 patients (52.5%) had non-ST-elevation myocardial infarction. The time between the beginning of the complaint and notification of NAS was regarded as the patient delay (PD). The time from the notification of NAS until arrival on the scene (M1), that of the on-site care (M2) and of the transport from the scene to the hospital (M3) were recorded. In-hospital care was evaluated from admission until opening the vessel ("door to balloon time"). The results were also broken down by counties. The median values and the quartiles (Q1, Q3) were given when the time was reported. Results: Patient delay in both types of infarction was unfavourably long: 101 minutes for STEMI and 687 minutes for NSTEMI. Immediate ambulance action was recorded in 58.7% for STEMI patients and 43.7% for NSTEMI patients. In both types of myocardial infarction, the median M1 time was 13 minutes, on-site care (M2) was 23 minutes, and M3 time was 30 minutes. In patients treated for STEMI, the time from hospital admission until opening the infarct-related artery was 37 minutes, and the total ischemic time was 243 minutes. In 9.5% of STEMI patients, the infarct-related artery was opened within 2 hours, in 49.1% within 4 hours, and in 88.1% within 12 hours. Significant differences were found between the counties for each of the periods examined. Conclusions: The PD is currently the biggest problem in providing optimal care timely for myocardial infarction patients. There are significant regional differences in rescue times, and further analysis is needed to investigate the causes. Orv Hetil. 2020; 161(12): 458-467.

[Myocardial infarction without obstructive coronary artery disease (MINOCA) - prevalence and prognosis]. / Obstruktív koszorúér-betegség nélkül kialakuló heveny szívizominfarktus (MINOCA) ­ gyakoriság és prognózis.

Introduction: There are conflicting data on the prevalence and prognosis of AMI patients with non-obstructive coronary artery disease (MINOCA). Aim: We studied the prevalence and prognosis of MINOCA patients. Method: In the Hungarian Myocardial Infarction Registry (HUMIR) 45,223 patients (pts) with acute myocardial infarction (AMI) were found who were treated between Jan 1, 2014, and June 30, 2018, and coronary arteriography was performed. ST-elevation myocardial infarction was diagnosed in 22,469 pts (49.7%). Patients without obstructive coronary artery disease who had no previous myocardial infarction, heart failure, PCI and CABG procedure were selected to the MINOCA group (n = 2003). Patients with obstructive coronary artery disease belonged to the MICAD group (n = 43,220). We investigated clinical characteristics of the patients, overall survival and reinfarction. Survival curves were estimated with the Kaplan-Meier method and were modeled with the Cox proportional hazards model. Results: The proportion of MINOCA pts among all myocardial infarction was by 4.4% higher in the STEMI pts compared to the NSTEMI group (2.0% vs. 6.8%). The MINOCA pts were younger (age 64.0 ± 14.4 vs. 65.5 ± 12.2 years), and the proportion of women was higher (55.7% vs. 36.5%). Hypertension, diabetes mellitus and peripheral artery disease were more common in the MICAD group (79.1% vs. 73.7%, 33.0% vs. 21.2%, and 12% vs. 8%). The mortality was higher among the MICAD pts. In the MINOCA group, the mortality of men did not differ between STEMI and NSTEMI, as opposed to women: women with STEMI had higher mortality than women with NSTEMI. The risk of reinfarction was higher in the MICAD group, especially in NSTEMI, the risk in the MINOCA group was lower, and there was no substantial difference between types. Conclusion: In this real word, retrospective, observational study, we found a significant difference in the prevalence of MINOCA pts according to different types of myocardial infarction. In the MINOCA group, the mortality of women with STEMI was substantially higher. Orv Hetil. 2019; 160(45): 1791-1797.

[Analysis of pre-hospital delay time of patients with myocardial infarction]. / Szívinfarktus miatt kezelt betegek prehospitális késési idejének elemzése.

INTRODUCTION AND AIM: The authors examined the pre-hospital delay of patients with ST-elevation myocardial infarction receiving percutaneous coronary revascularization. METHOD: In the Hungarian Myocardial Infarction Registry (HUMIR), between January 1, 2014 and March 31, 2016, 7146 patients were found who had all necessary time intervals available. In the database of the National Ambulance Service (OMSZ), 3288 patients were found who had the necessary time intervals. The following time intervals were investigated: the time from the beginning of the complaint to the rescue service notification (patient delay time = PDT), the time of the rescue service to arrive at the scene (R1), the on-site care time (R2) and the time from the scene until arriving to the centre (R3). The case of care at the centre, we investigated the time from the onset of symptoms until the balloon inflation (SBI). If the first hospital had no cardiac catheterization laboratory, we measured the transfer time to the cath centre. The methodological details related to the operation of the HUMIR had been described in our earlier communication. Rescue times (R1, R2, R3) were investigated on the basis of the paper-based records of the National Emergency Service. The patients were divided into two groups based on the fact that the first admission hospital is a centre with a heart catheter facility (C) or a non-invasive hospital (H). RESULTS: 2621 patients (79.7%) were admitted to a hospital with cath lab (C) and 667 patients with secondary transport. Patients with primary transport to C were younger, but for other data, the two groups did not differ. The median of PDT for patients in group C was 114, and 121 minutes for patients in group H. There was no significant difference between R1 and R2 time between the two groups. R3 time in group C was longer than for H patients. In the case of secondary transport, the median time was 98 minutes until the centre. The median time from the beginning of the complaint to the balloon inflation (total ischemic time) was 260 minutes in group C and 356 minutes in group H. CONCLUSION: Based on the analysis of the total ischemic time and the pre-hospital delay, it is clear that the care of myocardial infarction patients can be further improved by reducing the patient's decision time and increasing the proportion of primary transport. Rescue times (R1, R2, R3) met the expectations, however, further analysis of the M2 time should be considered. Orv Hetil. 2019; 160(1): 20-25.

[Prognostic significance of the total ischemic time in patients with ST-elevation myocardial infarction]. / A teljes ischaemiás ido prognosztikus jelentosége az ST-elevációval járó szívinfarktus miatt kezelt betegekben.

INTRODUCTION: The significance of the total ischemic time (from the beginning of the complaint to the opening of the vessel) is an important factor for myocardial salvage. AIM: The aim of the study was to determine the prognostic significance of the TIT in patients with ST elevation myocardial infarction in Hungary. METHOD: From 1 January 2014 all patients with myocardial infarction were recorded by law in an on-line database of the Hungarian Myocardial Infarction Registry. Between 1 January 2014 and 31 March 2016, 27 157 patients with 28 408 myocardial infarction events were recorded. To investigate TIT, 7146 STEMI patients were selected who were treated with percutaneous coronary intervention (PCI) within 24 hours of the beginning of the complaint and all of its components were known. RESULTS: Average follow-up was 740 ± 346 days. The median time of the TIT is 260 minutes, within which the earliest prehospital time was found (median 205 minutes). The TIT influenced survival: if this time was less than 400 minutes, the 30-day and the 1-year deaths were 7.5% and 12.2%, respectively. In longer TIT, higher mortality rate was found (9.2% versus 19.7%, respectively). Multivariate analysis was performed for short (<30 days), medium (30-364 days) and long-term (≥365 days) survival. Diabetes mellitus is a short-term prognostic factor, abnormal creatinine, and severe coronary status have affected short and medium survival. PCI was significant in terms of medium and long-term survival. Previous myocardial infarction and TIT influenced the long-term survival significantly. CONCLUSIONS: In Hungary, TIT is too long, and its dominant part falls within the prehospital period. The TIT is an independent prognostic factor, so reducing this time can improve the long-term prognosis of patients with ST-elevation myocardial infarction. Orv Hetil. 2018; 159(27): 1113-1120.

[Effect of smoking on survival after myocardial infarction - smoker's paradox in Hungary?] / A dohányzás hatása a szívinfarktus utáni túlélésre ­ dohányzási paradoxon Magyarországon?

INTRODUCTION: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic significance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the "smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. AIM: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profiles. METHOD: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis - with Cox proportional hazards model and Accelerated Failure Time models - is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. RESULTS: Both the short term - 30 day - mortality (OR = 1.517, 99% confidence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confidence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. CONCLUSION: The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis. Orv Hetil. 2018; 159(14): 557-565.

[The significance of ECG recorded at hospitalization in determining the prognosis of patients treated with myocardial infarction]. / A kórházi felvétel idején rögzített EKG jelentosége a szívinfarktus miatt kezelt betegek prognózisának meghatározásában.

INTRODUCTION AND AIM: By using the database of the National Registry of Myocardial Infarction, the authors examine the prognosis of patients treated with acute myocardial infarction, in case of whom there was new or presumably new left bundle branch block (nLBBB) on the ECG recorded at hospitalization. METHOD: We recorded the details of 18 091 patients treated with acute myocardial infarction (AMI) between 1 January 2014 and 30 June 2015 in the National Registry of Myocardial Infarction. In case of 8334 patients, the clinical diagnosis was ST-elevation myocardial infarction (STEMI), whereas in 9757 cases it was non-ST elevation myocardial infarction (NSTEMI). In the STEMI population we examined the clinical characteristics and prognosis of patients with ST-elevation (n = 7937) and nLBBB (n = 397). We used the proportional hazards regression model (Cox-regression) to examine mortality. RESULTS: In the AMI patient population, we found LBBB in 1274 cases (7%). In case of STEMI clinical diagnosis, the patients belonging to the nLBBB subpopulation (n = 397) were older, and the proportion of men and the occurrence of co-morbidities was higher than in case of those who had ST-elevation on their ECG recorded at hospitalization. The mortality rate of the LBBB population was higher than that of the ST-elevation patient population in both the 30-day (25.4% versus 12.4%) and the 1-year period (47.3 versus 19.9%). Percutaneous coronary intervention (PCI) had significantly lower mortality in both populations. In the course of a multifactorial analysis we verified the independent prognostic significance of LBBB: the hazard ratio compared to ST-elevation was 1.33 (95% confidence interval: 1.10-1.62), checked for gender, age, occurrence of PCI, systolic blood pressure, cardiac frequency, serum creatinine difference, and the details of five anamneses/co-morbidities. CONCLUSION: The admission ECG has prognostic significance. Patients with LBBB have poorer prognosis compared to patients with ST-elevation on admission ECG. Orv Hetil. 2018; 159(17): 677-681.

[Adherence to medication after myocardial infarction and its impact on outcome: a registry-based analysis from the Hungarian Myocardial Infarction Registry]. / Szívinfarktust túlélt betegek terápiahusége a másodlagos megelozés szempontjából fontos gyógyszeres kezelésekhez.

INTRODUCTION AND AIM: The aim was to study the patients' adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome. METHOD: Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model adherence and survival time. RESULTS: Good adherence (\>80%) to clopidogrel, statins, beta blockers, aspirin and ARB/ACEI was found in 64.9%, 54.4%, 36.5%, 31.7% and 64.0%, respectively. Patients treated with PCI during the index hospitalization had higher adherence to all medication (all p<0.01), except for beta-blocker (p = 0.484). Multivariate analysis confirmed that adherence to statins, to clopidogrel and ARB/ACEI-inhibitors was associated with 10.1% (p<0.0001), 10.4% (p = 0.0002) and 15.8% (p<0.0001) lower hazard of endpoint respectively for 25% points increase in adherence, controlling for age, sex, performing of PCI, 5 anamnestic data and date of index event. Adherence to aspirin and beta blockers was not significantly associated with the hazard. CONCLUSION: Higher adherence to some evidence-based medications was found to be associated with improved long term prognosis of the patients. Orv Hetil. 2017; 158(27): 1051-1057.

[Atypical complaint in myocardial ischaemia: belching]. / Atípusos panasz myocardialis ischaemiában: böfögés.

While educating non-medical personnel on acute coronary syndrome we often emphasize the importance of early recognition and urgent transfer to acute cardiac center of patients with acute myocardial infarction. Aside from typical symptoms of chest tightness and pain radiating to shoulder, arm and jaw, angina often presents with atypical, non-cardiac complaints. These symptoms, often suggesting gastrointestinal problems, can sometimes mislead even the most experienced physicians. We would like to present the case of an 83-year-old woman with several decades long history of ischaemic heart disease, who recently developed a new anginal symptom: lound, uncontrollable belching. Within the past eight months she was admitted four times with complaints of belching followed by chest pain. Even though initially it was thought as an incidental finding, in all four cases she had proven coronary occlusion requiring cardiac intervention. Orv. Hetil., 2017, 158(5), 183-186.

[Patient care of patients with myocardial infarction in Hungary. Analysis of National Myocardial Infarction Registry data collecting in 2015]. / A szívinfarktus miatt kezelt betegek ellátása Magyarországon. A Nemzeti Szívinfarktus Regiszter 2015. évi adatainak elemzése.

The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure. CONCLUSION: comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90-93.

[Treatment of patients with myocardial infarction in Hungary on the basis of available health data]. / Szívinfarktus miatt kezelt betegek ellátásának vizsgálata Magyarországon a rendelkezésre álló egészségügyi adatok alapján.

The authors review data sources related to death arising from myocardial infarction, as well as the major elements of the Hungarian data collection of the Central Statistical Office, the National Health Insurance Fund and the National Registry of Myocardial Infarction. They also discuss conclusions which can be drawn from the data. It was found that the financial database - in accordance with its purpose - is suitable for monitoring the costs arising during the treatment of patient, but the quality and efficiency of treatment cannot be judged on the basis of this database. The Central Statistical Office compiles mortality data on the basis of international conventions, the basis of which is the autopsy report. However, the validity of statistical data depends on the correct completion of this report. Therefore. it is not possible to judge treatment of patients with myocardial infarction simply on the basis of mortality statistics. Considering national databases, only patient registries are suitable for monitoring the quality and efficiency of treatment currently. It is recommended that data of the National Registry of Myocardial Infarction should be used when the quality of treatment of patients with myocardial infarction is evaluated.

[Comparison of the clinical characteristics and hospital treatment of myocardial infarction with and without ST-segment elevation in Hungary. National Registry of Myocardial Infarction]. / Az ST-elevációval járó és az ST-elevációval nem járó szívinfarktusos betegek klinikai adatainak és kórházi ellátásának összehasonlítása. Nemzeti Szívinfarktus Regiszter.

INTRODUCTION: Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary. AIM: To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database. METHOD: Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis. RESULTS: Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction. CONCLUSIONS: The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups.