Gottsegen National Institute of Cardiology. Prof. A. JÁNOSI

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Henrik Nemes
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1 Myocardial Infarction Registry Pilot Study Hungarian Myocardial Infarction Register Gottsegen National Institute of Cardiology Prof. A. JÁNOSI

2 A A Web based study with quality assurance 12006

Myocardial Infarction Register Pilot Study Study population in Budapest: II. district: 88729 III. district: 123723 IX. district: 61576 X.

district: 78250 Population in Budapest: 1 712 210 431 998 inhabitants Budapest Szabolcs-Szatmár-Bereg county Budai Irgalmasrendi Kórház Szent János

3 Myocardial Infarction Register Pilot Study Study population in Budapest: II. district: III. district: IX. district: X. district XVII. district: Population in Budapest: inhabitants Budapest Szabolcs-Szatmár-Bereg county Budai Irgalmasrendi Kórház Szent János Kórház Állami Egészségügyi Központ Bajcsy-Zsilinszky Kórház Szent István Kórház Országos Kardiológiai Intézet Jósa András Oktató Kórház, Nyíregyháza Felső-Szabolcsi Kórház Kisvárda Szatmár-Beregi Kórház, Fehérgyarmat Területi Kórház Mátészalka POPULATION REGISTER HOSPITAL REGISTER

4 Participating centers in the pilot study Budapest - ÁEK - Bajcsy Zs. Kh. - BIK - GOKI - SE Kardiológiai Központ - Szent István Kh. - Szent János Kh. 1 th. - Szent János Kh. 2 th. Kisvárda Fehérgyarmat Nyíregyháza Mátészalka

5 SOURCES OF DATA National Statistical Office HOSPITALS National Health Insurance Office MMyocardial Infarction Registry FOLLOW UP

Myocardial Infarction Pilot Study 01.01.2010.-12.31.2011.

6 Myocardial Infarction Pilot Study Number of patients:8071 Coronarography in STEMI patients Hospital diagnosis STEMI: 53.9% NSTEMI: 41.8% CA was perfrmed 86.3%-of STEMI pts

7 Primary PCI in pts with STEMI STEMI N= 4425 Dia 19,5% Late comer :9% 21% 80.5 %

8 Main results of the pilot study 1. The Web based Myocardial Infarction Register Pilot Study was found feasible and it is a valuable tool to have real picture on pts care and improve the quality of care 2. The number of participating centers increased from 12 to 36.

feasible and it is a valuable tool to have real picture on pts

Hungarian Myocardial Infarction Registry 01. 01. 2012. Szombathely Zalaegerszeg (HCF) Győr Budapest - ÁEK (HCF) - Bajcsy Zs. Kh. (HCF) - BIK (HCF) - GOKI (HCF) - Károlyi S. Kh. - SE Kardiológiai Központ (HCF) - Szent Imre Kh.

9 Hungarian Myocardial Infarction Registry Szombathely Zalaegerszeg (HCF) Győr Budapest - ÁEK (HCF) - Bajcsy Zs. Kh. (HCF) - BIK (HCF) - GOKI (HCF) - Károlyi S. Kh. - SE Kardiológiai Központ (HCF) - Szent Imre Kh. - Szent István Kh. - Szent János Kh. 1 th. - Szent János Kh. 2 th. Székesfeférvár HCF CHF Balatonfüred Dunaújváros Eger Cegléd Miskolc Szolnok HCF Kisvárda Nyíregyháza (HCF) Békéscsaba Gyula Fehérgyarmat Mátészalka Debrecen (HCF) Nagykanizsa Pécs -PTE I.Bel. Klinika -PTE Szívgyógyászati Klinika (HCF) Kecskemét Kaposvár Szekszárd Szeged (HCF) Centers participating in the pilot study Centers joined later

Székesfeférvár HCF CHF Balatonfüred Dunaújváros Eger Cegléd Miskolc Szolnok HCF Kisvárda Nyíregyháza (HCF) Békéscsaba Gyula Fehérgyarmat Mátészalka Debrecen

10 Primary PCI for ST segment elevation myocardial infarction- an analysis of registry data A. Jánosi 1, K. Csapó 2, I. Ungi 3, I. Édes 4, P. Polgár 5, L. Nagy 6, G. Lupkovics 7, K. Zámolyi 8 1 Gottsegen György Országos Kardiológiai Intézet 2 Miskolci Megyei Kórház 3 Szegedi Egyetem II. Belklinika - Kardiológiai Központ 4 Jósa András Kórház Nyíregyháza 5 DOTE Kardiológiai Intézet 6 Markosovszky Kórház Szombathely 7 Zala Megyei Kórház 8 Bajcsy Kórház, Budapest

Zámolyi 8 1 Gottsegen György Országos Kardiológiai Intézet 2 Miskolci Megyei Kórház 3 Szegedi Egyetem II.

11 Patients and methods 1. In the Myocardial Infarct Registry we identifed rural centres which have registered at least 200 AMI pts during the period between 01/1/2011 and 31/12/2011 and have heart cath facility. 2. The rural centres were compared to a center in the capital, which has heart cath facility without heart surgery on site 3. Data from 2397 pts have been processed: 394 pts were registered in the capital, and 2003 cases came from the countryside.

the period between 01/1/2011 and 31/12/2011 and have heart cath facility. 2.

12 STEMI/AMI (%) in different centres BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county

Coronarography and PPCI in STEMI patients 100 90 80 70 60 50 40 30 20 10 0 BAZ Cs F HB SzSzB V Z average Bajcsy kh CA (%) 100 96 95 94 85 100 100 95,7 96 PPCI (%) 99 91 88 98 78 93 99 92,3 84 BAZ=

13 Coronarography and PPCI in STEMI patients BAZ Cs F HB SzSzB V Z average Bajcsy kh CA (%) ,7 96 PPCI (%) ,3 84 BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county; CA= coronary arteriogriography; PPCI= primer percutan coronary intervention

Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg

Late comer STEMI patients 20 18 LATE COMER>24H 16 14 12 AVERAGE 10 8 6 4 2 0 BAZ Cs F HB SzSzB V Z average Bajcsy Kh % 16 14 4 10 6,6 12,5 18,3 11,6 11 BAZ=

14 Late comer STEMI patients LATE COMER>24H AVERAGE BAZ Cs F HB SzSzB V Z average Bajcsy Kh % ,6 12,5 18,3 11,6 11 BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county;

15 Late comer and PPCI % BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú- Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county;

16 Door to ballon time Average 54 vs. 55 minutes

Time from onset of symptoms to balloon inflation 300 60 minutes 250 200 150 100 50 0 BAZ Cs F HB SzSzB V Z average Bajcs Kh minutes 275 252 245 255 280 205 300 259

17 Time from onset of symptoms to balloon inflation minutes BAZ Cs F HB SzSzB V Z average Bajcs Kh minutes BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county;

199 BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB=

18 Hospital mortality average BAZ Cs F HB SzSzB V Z average % ,1 2 Bajcsy Kh.-Bp. BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs-Szatmár-Bereg county; V= Vas county; Z= Zala county

19 Hospital mortality and use of IABP BAZ Cs F HB SzSzB V Z Bajcsy Kh.-Bp. IABP (%) Halálozás (%) BAZ= Borsod Abaúj Zemplén county; Cs= Csongrád county F= Fejér county; HB= Hajdú-Bihar county; SzSzB= Szabolcs- Szatmár-Bereg county; V= Vas county; Z= Zala county

IABP (%) 4 4 1 5 14 16 5 3 Halálozás (%) 2 2 4 3 8 3 3 2 BAZ= Borsod Abaúj

20 Conclusions 1. PPCI was significantly more frequent in rural centers than in the capital (92.3% vs.84%). 2. In the countryside the median time to the reopening of the culprit vessel was 60 minutes longer than in the capital 3. No correlations were found between frequency of the late comer patients and frequency of PPCI

21 The program was founded Health Scientific Counsil (ETT) ) MSD ASTRAZENECA EGIS, SERVIER, RICHTER Research grants

22 SWEDEHEART HUNGAROHEART Yes, we can do it Many thanks for all of you for your cooperation. Our common goal to have an effective cardiac care in Hungary. Different registries are badly needed for this, therefore we have to continue our work.

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