Epidemiology and management of myocardial infarction at Fribourg Cantonal Hospital, 1995

Purpose: This study evaluates epidemiological data in a population of patients admitted for acute myocardial infarction in a large Swiss community hospital. It focuses on the application of recent drug treatment and newer therapeutic techniques. Method: Data acquisition was based on medical records of all patients who were admitted to the Cantonal Hospital of Fribourg in 1995. Their one-year follow-up was obtained through questionnaires sent to general practitioners. Results: During the study period: 146 myocardial infarctions were diagnosed in 144 patients. Median age was 67.1 and 35% of patients were female. Nineteen percent were diabetics, 51% had hypertension and 28% had a positive family history for coronary artery disease. Active smokers made up 32%, 17% were past smokers. Myocardial infarction was anterior in 40%, inferior in 36% and non-Q wave myocardial infarction in 35%. Eighteen percent were subacute myocardial infarction. Killip class on admission were as follow: class I 65%, class II 21%, class III 1% and class IV 11%. Thrombolytic treatment was administered in 29% of patients. Vasoactive amines were used in 27% of patients and 8% were intubated some time during their hospital stay. At hospital discharge 81% were treated with Aspirin, 31% with anticoagulants, 47% with an ACE inhibitor, 38% with a beta-blocker, 34% with nitrates and 25% with a calcium antagonist. Among this population, 62% had an echocardiogram, 30% a stress test and 8% a Holter recording. Coronary angiography was performed in 52%, which revealed 33% one-vessel disease, 28% two-vessel disease, 25% three-vessel disease and 9% normal coronary arteries. Percutaneous coronary angioplasty was done in 53% of cases and a coronary stent implanted in 22%. Twelve percent had surgical revascularization. The mean hospital stay was 16.3 +/- 10.8 days, with in hospital mortality of up to 19.2% and a one-year mortality of 25.3%. Conclusion: Treatment modalities of patients admitted for acute myocardial infarction at the Hospital of Fribourg are comparable with literature data. Hypolipemic treatment has not been prescribed as often as recent guidelines recommend, but the use of ACE inhibitors was more common. As in other studies, older patients have the highest mortality. The absence of hospital coronarography facility did not seem to influence the prognosis of that population.