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

• Published in: Acta cardiologica 2000-12, Vol.55 (6), p.357-366
• Main Authors: DE GEVIGNEY, Guy, ECOCHARD, René, COLIN, Cyrille, RABILLOUD, Muriel, EXCOFFIER, Sylvie, CAO, Danièle, CHENEAU, Edouard, MILON, Hugues, DELAHAYE, Francois
• Format: Article
• Language: English
• Subjects: Age of Onset; Aged; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Female; Fibrinolytic Agents - therapeutic use; France - epidemiology; Heart; Hospital Mortality - trends; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Odds Ratio; Prognosis; Prospective Studies; Risk Factors; Sex Distribution; Thrombolytic Therapy - statistics & numerical data
• ISSN: 0001-5385; 1784-973X
• DOI: 10.2143/AC.55.6.2005767

The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regardless of age and hospital facilities, in the "real world" in a region in France. Data were prospectively collected in all patients with MI admitted in all hospitals in three departments in the Rh ne-Alpes region 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 to 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 was significantly higher in men than in women, in younger patients than in older patients, in lower Killip classes, in Q wave MI, and when the delay before initial medical intervention was < 6 hours. After age-adjustment, there 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 identified age, anterior location, presence of Q waves, and higher Killip classes as significant predictors of in-hospital mortality. This large unselected cohort revealed that among patients with MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.