Aim

The aim was to study retrospectively the possible changes in practice patterns in the management of patients with acute myocardial infarction who were admitted to the State Second Central Hospital during the last 5 years.

Material and Method

This study conducted at the State Second Central Hospital in September 2014. Patients with acute myocardial infarction were divided into 2 groups: main and control. Main group

included 95 patients with myocardial infarction who were treated from 2010 to July 2014. Control group included 102 patients with myocardial infarction who were treated from 2005 to 2009. From 2005 to 2012 patients fulfilled the diagnostic criteria of myocardial infarction based on WHO criteria. From 2013 to 2014 patients fulfilled the diagnostic criteria of myocardial infarction based on national guideline’s criteria. Differences in proportions in the groups were tested with the chi square test. P value of <0.05 was considered significant.

Results

A total 197 patients (mean age 71.2±6.1, 62% man, and 38% women) with acute myocardial infarction were enrolled. More than half had a history of arterial hypertension. Atypical forms of myocardial infarction increased from 25.8% in 2005-2009 to 40.4% in 2010-2014. ST elevation myocardial infarction and non ST elevation myocardial infarction were detected in 61% and 39% of patients treated in 2010-2014. Diagnostic use of troponin was increased significantly in last 5 year (44.2% vs. 88.6%, p<0.05).

The study revealed only 17.2% of patients with acute myocardial infarction met the national guidelines goal of pre-hospital time <12 hours. Eighty four (88.3%) patients of the main  group received medical therapy and 11(11.7%) treated with percutaneous coronary intervention. Aspirin was prescribed in 80.7% of main group, heparin in 97.9%, ACE inhibitors in 47.9%, Beta blocker in 14.9% within 24 hours of acute myocardial infarction.

Conclusions

Compared with control group use of troponin and invasive treatment strategy has increased since 2010 in the management of patients with acute myocardial infarction. Delay of pre-hospital time remains an actual problem in the management of acute myocardial infarction.

Key words: AMI, pre-hospital time, troponin, PCI, medical therapy

Pp. 55-59, Table 1, Figures 4, References 5

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