Treatment and clinical course of myocardial infarction (MI) in Polish and world centers participating in ISIS-4
Budaj A., Collins R., Cedro K., Cybulski J., Ptaszynska A., Ceremuzynski L.
Multicenter trials are important source of clinical information. Treatment and clinical course of MI have been analyzed in 3493 pts from 23 Polish centers and 57820 pts from 1063 hospitals in various countries participating in ISIS-4. The following methods of treatment were used in 'Poland' and 'World' respectively: thrombolytics 39.4 vs 69.7%, p <0.0001, ASA 94.0 vs 94.3%, NS, beta blockers iv 2.0 vs 8.9%, p < 0.0001, invasive procedures (PTCA or CABG) 0.3 vs 4.6%, p<0.0001, nitrates iv 80.7 vs 53.7%, p<0.0001, diuretics 6.9 vs 11.5%, p<0.0001, antiarrhythmics 26.1 vs 20.8%, p<0.0001. The incidence of interventions established in the treatment of MI (thrombolytics, beta blockers, invasive procedures) was significantly lower in Polish centers. Nitrates and antiarrhythmics were used more often. Only ASA was used with similar high frequency. MI complications occurred in 'Poland' and 'World' respectively: heart failure 25.5 vs 17.3%, p<0.0001, recurrent coronary pains 21.3 vs 16.2%, p<0.0001, cardiac arrest 9.7 vs 7.5%, p<0.0001. Serious complications of MI occurred more frequently in Polish population of pts. Suboptimal treatment of MI and high frequency of complications recorded in Polish centers should stimulate proper actions to be undertaken to improve this situation.