Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway, and Sweden according to national ongoing registries

Mai Blöndal; Tiia Ainla; Jaan Eha; Piret Lõiveke; Toomas Marandi; Aet Saar; Gudrun Veldre; Robert Edfors; Christian Lewinter; Tomas Jernberg; Jarle Jortveit; Sigrun Halvorsen; Dávid Becker; Zoltán Csanádi; Tamas Ferenci; Péter Andréka; András Jánosi

doi:10.1093/ehjqcco/qcaa098

Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway, and Sweden according to national ongoing registries

Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):307-314. doi: 10.1093/ehjqcco/qcaa098.

Authors

Mai Blöndal^{1

2}, Tiia Ainla^{1

3}, Jaan Eha^{1

2}, Piret Lõiveke^{1

3}, Toomas Marandi^{1

3

4}, Aet Saar³, Gudrun Veldre⁵, Robert Edfors^{6

7}, Christian Lewinter⁸, Tomas Jernberg⁶, Jarle Jortveit⁹, Sigrun Halvorsen^{10

11}, Dávid Becker¹², Zoltán Csanádi¹³, Tamas Ferenci¹⁴, Péter Andréka¹⁵, András Jánosi¹⁵

Affiliations

¹ Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014 Tartu, Estonia.
² Department of Cardiology, Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, 51014 Tartu, Estonia.
³ Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia.
⁴ Quality Department, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia.
⁵ Estonian Myocardial Infarction Registry, Tartu University Hospital, 8 L. Puusepa Street, 51014 Tartu, Estonia.
⁶ Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm 182 88, Sweden.
⁷ Bayer AB, 35 Berzelius road, 171 65 Solna, Sweden.
⁸ Heart and Vascular Theme, Karolinska University Hospital, Eugeniavägen 3, 171 76, Solna, Sweden.
⁹ Department of Cardiology, Sorlandet Hospital, PO Box 783, Stoa, 4809 Arendal, Norway.
¹⁰ Department of Cardiology, Oslo University Hospital, Ullevål Hospital, PB 4956, Nydalen, 0424 Oslo, Norway.
¹¹ Department of Cardiology, University of Oslo, OUS HF Rikshospitalet, PB 4950, Nydalen, 0424 Oslo, Norway.
¹² Semmelweis University Heart and Vascular Center, 9 Gaál József Street, Budapest 1120, Hungary.
¹³ University of Debrecen, Cardiology and Heart Surgery Clinic, 22 Móricz Zsigmond Street, Debrecen 4032, Hungary.
¹⁴ Obuda University, John von Neumann Faculty of Informatics, Applied Informatics Institute, Physiological Controls Group, Becsi ut 96/B, 1034 Budapest, Hungary.
¹⁵ Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, 29 Haller street, 1096 Budapest, Hungary.

PMID: 33710273
DOI: 10.1093/ehjqcco/qcaa098

Abstract

Aims: Describe the characteristics, management and outcomes of hospitalized ST-segment elevation myocardial infarction (STEMI) patients according to national ongoing myocardial infarction registries in Estonia, Hungary, Norway, and Sweden.

Methods and results: Country-level aggregated data was used to study baseline characteristics, use of in-hospital procedures, medications at discharge, in-hospital complications, 30-day and 1-year mortality for all patients admitted with STEMI during 2014-2017 using data from EMIR (Estonia; n = 4584), HUMIR (Hungary; n = 23 685), NORMI (Norway; n = 12 414, data for 2013-2016), and SWEDEHEART (Sweden; n = 23 342). Estonia and Hungary had a higher proportion of women, patients with hypertension, diabetes, and peripheral artery disease compared to Norway and Sweden. Rates of reperfusion varied from 75.7% in Estonia to 84.0% in Sweden. Rates of recommendation of discharge medications were generally high and similar. However, Estonia demonstrated the lowest rates of dual antiplatelet therapy (78.1%) and statins (86.5%). Norway had the lowest rates of beta-blockers (80.5%) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (61.5%). The 30-day mortality rates ranged between 9.9% and 13.4% remaining lowest in Sweden. One-year mortality rates ranged from 14.8% in Sweden and 16.0% in Norway to 20.6% in Hungary and 21.1% in Estonia. Age-adjusted lethality rates were highest for Hungary and lowest for Sweden.

Conclusion: This inter-country comparison of data from four national ongoing European registries provides new insights into the risk factors, management and outcomes of patients with STEMI. There are several possible reasons for the findings, including coverage of the registries and variability of baseline-characteristics' definitions that need to be further explored.

Keywords: Mortality; Real-world evidence; Registry study; ST-segment elevation myocardial infarction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Angiotensin Receptor Antagonists / therapeutic use
Estonia
Female
Humans
Hungary / epidemiology
Myocardial Infarction*
Registries
ST Elevation Myocardial Infarction* / epidemiology
ST Elevation Myocardial Infarction* / therapy
Sweden / epidemiology

Substances

Angiotensin Receptor Antagonists