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