CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.081227.
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Research

In-hospital case fatality rates for acute myocardial infarction in Romania

Gabriel Tatu-Chitoiu, MD PhD, Mircea Cinteza, MD PhD, Maria Dorobantu, MD PhD, Mariana Udeanu, MD PhD, Olivia Manfrini, MD, Carmine Pizzi, MD, Marius Vintila, MD PhD, Dominic D. Ionescu, MD PhD, Elvira Craiu, MD PhD, Daniel Burghina, MD PhD and Raffaele Bugiardini, MD

From the Floreasca Emergency Hospital (Tatu-Chitoiu, Dorobantu); the Emergency University Hospital (Cinteza, Udeanu); the Emergency St. Pante-limon Hospital (Vintila), Bucharest, Romania; the Center of Cardiology (Ionescu), Craiova, Romania; the Department of Cardiology (Craiu), County Hospital Constanta, Constanta, Romania; the Department of Internal Medicine (Burghina [deceased]), Municipality Hospital Timisoara, Timisoara, Romania; and the University of Bologna (Udeanu, Manfrini, Pizzi, Bugiardini), Bologna, Italy

Correspondence to: Dr. Raffaele Bugiardini, Dipartimento di Medicina Interna, dell’Invecchiamento e Malattie Nefrologiche (Padiglione 11), University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; fax 39 051347290; raffaele.bugiardini{at}unibo.it

Background: We describe the clinical characteristics, treatments and in-hospital case-fatality rates in an unselected population of patients admitted for acute myocardial infarction.

Methods: From January 2000 to June 2007, we tracked consecutive patients who were admitted to 7 tertiary referral and 21 county hospitals in Romania for medical treatment of ST-segment elevation acute myocardial infarction. These patients were enrolled in the Romanian Registry for ST-segment Elevation Myocardial Infarction. For this prospective study, we collected data on demographic characteristics, cardiovascular risk factors, various aspects of treatment for myocardial infarction, and in-hospital death.

Results: The 9186 patients in the study group had a mean age of 63.8 years. The median time from onset of symptoms to thrombolysis was 230 (interquartile range 120–510) minutes. Of the 9186 patients, 4986 (54.3%) had hypertension, 1974 (21.5%) had diabetes mellitus, 3545 (38.6%) had lipid disorders and 4653 (50.7%) were smokers. The in-hospital mortality rate was 12.7% (1170 deaths). The study group consisted of 2893 women and 6293 men. The women were older than the men and had higher rates of hypertension and diabetes mellitus but were less likely to be smokers. A smaller proportion of women than men presented within 2 hours after onset of symptoms (23.1% v. 34.4%, p < 0.001). Smaller proportions of women received thrombolytics (40.8% v. 53.5%, p < 0.001), anticoagulants (93.4% v. 95.2%; p = 0.001), antiplatelet agents (88.3% v. 91.2%, p < 0.001) and primary percutaneous coronary interventions (1.5% v. 2.2%, p = 0.030). The risk of in-hospital death was greater for women, even after adjustment for confounders (odds ratio 1.33, 95% confidence interval 1.13–1.56; p < 0.001).

Interpretation: The rates of reperfusion therapy for patients with acute myocardial infarction were low, and in-hospital case-fatality rates were high in this study. Excess in-hospital mortality was more pronounced among women.


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M. Bobak and H. Hemingway
Quality of acute coronary care in emerging economies
Can. Med. Assoc. J., June 9, 2009; 180(12): 1190 - 1191.
[Full Text] [PDF]