Differences in trends in estimated incidence of myocardial infarction in non-diabetic and diabetic people: Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) registry.

AIMS/HYPOTHESIS: One major objective of the St Vincent Declaration was to reduce the excess risk of myocardial infarction in patients with diabetes mellitus. We estimated the trend of the incidence and relative risk of myocardial infarction in the diabetic and non-diabetic populations in southern Germany from 1985 to 2006. METHODS: Using data from the Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) Project in southern Germany, we ascertained all fatal and non-fatal first myocardial infarctions between 1985 and 2006 (n = 14,891, age 25-74 years). We estimated the diabetic and the non-diabetic populations using data on diabetes prevalence from surveys, and evaluated incidence of myocardial infarction in the two estimated populations. To test for time trends, we fitted Poisson regression models. RESULTS: Of individuals with first myocardial infarction, 71% were male and 28% known to have diabetes. In the non-diabetic population, myocardial infarction incidence decreased by about 1.5% to 2.0% per year. A comparable decrease was seen in the population of diabetic women. However, in the population of diabetic men, incidence of myocardial infarction increased by about 1% per year. Over the whole study period, myocardial infarction incidence decreased by 34% and 27% in non-diabetic men and women respectively (RR 0.66, 95% CI 0.59-0.74 and 0.73, 0.62-0.87 respectively). In diabetic women, it decreased by 27% (RR 0.73, 0.61-0.88), whereas in diabetic men, it increased by 25% (RR 1.25, 1.07-1.45). CONCLUSIONS/INTERPRETATION: Our results suggest that the St Vincent goal of reducing excess cardiovascular morbidity in diabetic individuals has not been achieved and that the situation in men has actually got worse.

The population-based acute myocardial infarction (AMI) registry of the MONICA/KORA study region of Augsburg.

The population-based MONICA/KORA registry of acute myocardial infarction (AMI) for the study population of Augsburg was established in 1984. The major task was the description of time trends of AMI morbidity, ischaemic heart disease (IHD) mortality per 100,000 population and their underlying determinants. Results of 18 years of registration are presented stratified by gender and discussed from a public health point of view. From 1985 through 2002 a total number of 17,884 cases of AMI and IHD deaths (12,798 male; 5,086 female cases; age 25-74 years) were registered and validated according to MONICA rules. In the course of time, IHD mortality per 100,000 population decreased from 280 to 168 in men and from 88 to 54 in women; AMI morbidity decreased from 542 to 404 in men, and from 171 to 122 AMI in women. The important decrease of IHD mortality was mainly explained by a decline of recurrent events and a reduction of 28-day case fatality (men from 52 % to 42 %, women from 52 % to 44 %) as result of an intensified invasive reperfusion therapy and evidence-based drug medication. The presented results show positive developments, but underscore the necessity for increased primary prevention.

[Sex specific trends of sudden cardiac death and acute myocardial infarction: results of the population-based KORA/MONICA-Augsburg register 1985 to 1998]. / Geschlechtsspezifische Trends von plötzlichem Herztod und akutem Herzinfarkt - Ergebnisse des bevölkerungsbasierten KORA1/MONICA Augsburg Herzinfarkt-Registers 1985 bis 1998 -

BACKGROUND AND AIM: Myocardial infarction (MI) is the main single cause of death in adult populations. For the MONICA Augsburg population, MI-morbidity, mortality, and 28-day case fatality and their determinants were assessed by gender, and suggestions for an intensified acute care program were presented. PATIENTS AND METHODS: From 1985 to 1998, 13 499 25- to 74-year-old MI cases (9537 men, 3962 women) were registered; 7873 cases (5300 men, 2573 women) died within 28 days. Cardiac deaths were identified by regional health departments; causes of death were validated by the last treating physician and the coroner (response > 90 %). Hospitalized patients were interviewed about history and circumstances of the acute event; treatment data were abstracted from hospital charts. The prehospital phase, the first and the 2nd to 28thday after hospitalization were analyzed separately. RESULTS: MI-morbidity per 100 000 population declined from 560 to 397 MI cases in men and from 161 to 145 in women; mortality decreased from 317 to 232 in men and from 101 to 96 in women. The decline in men was due to decreasing incident and recurrent MI whereas in women it was only due to a reduction of recurrent MI. One third died before hospitalization, mainly at home. Case fatality (CF) on the first day in hospital increased. In 24 hour survivors, evidence based treatment increased considerably, and was accompanied by decreasing 28-day-CF from 13.0 % to 8.4 % in men, and from 12.5 % to 10.7 % in women. CONCLUSION: Aggressive risk factor management and education of patients with cardiovascular risk factors concerning acute symptoms and the use of the emergency system will consequently improve pre-hospital and 28-day survival of the population.

Incidence and prevalence of juvenile arthritis in an urban population of southern Germany: a prospective study.

OBJECTIVE: To ascertain the incidence and prevalence of juvenile arthritis in a German urban population. METHODS: All 766 paediatricians, orthopaedists, and rheumatologists working in practices or outpatient clinics in 12 south German towns were asked to report all patients who consulted them for juvenile arthritis during the year 1995. Patients with continuing symptoms were followed up for 9-12 months to obtain a final diagnosis. Extended measures of quality control were taken to control for known biases. RESULTS: Of 457 reported cases, 294 were diagnosed with para-/postinfectious arthritis (PPA), 78 with juvenile chronic arthritis (JCA), and 18 with other forms of arthritis. Half of the PPA cases were classified as transient synovitis of the hip (SH). For JCA the reported annual incidence was 6.6 and the prevalence 14.8 per 100 000 subjects under 16 years of age. For PPA the reported incidence was 76 and the prevalence 4.4 per 100 000 subjects under 16. The incidence of rheumatic fever was clearly below 1 per 100 000 people under 16. A correction model was used to control for known biases and to adjust the estimates accordingly. CONCLUSIONS: The results of this first prospective study on the incidence and prevalence of juvenile arthritis in Germany are consistent with a retrospective study performed in the Berlin area. Based on these results it was estimated that the annual frequency of juvenile arthritis in Germany is as follows: 750-900 incident JCA cases, 21 000 incident SH cases, and 21 000 incidence cases of other forms of PPA a year. The number of incidence cases of rheumatic fever is expected to be markedly lower than 150 a year. The total prevalence is expected to be 3600-4350 JCA cases, 2250-3000 SH cases, and the same number of other forms of PPA.

DNA binding properties of the marine sponge pigment fascaplysin.

Association of fascaplysin with double-stranded calf thymus DNA was investigated by means of isothermal titration calorimetry, absorption spectroscopy, and circular dichroism. The UV spectroscopic data could be well interpreted in terms of a two-site model for the binding of fascaplysin to DNA revealing affinity constants of K1 = 2.5 x 10(6) M(-1) and K2 = 7.5 x 10(4) M(-1) (base pairs of DNA). Based on the typical change observed in the absorption and circular dichroism spectra, intercalation of fascaplysin is regarded as the major binding mode. The calorimetric titration curves showed an exothermic reaction which was exhausted at a 2:1 base pair/drug; ratio. This finding is in agreement with an intercalation model comprising nearest neighbor exclusion. In addition, significantly weaker non-intercalative DNA interactions can be observed at high drug concentration. By comparison of all these data with the binding behavior of known intercalating agents, it is concluded that fascaplysin intercalates into DNA.

The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study.

AIMS/HYPOTHESIS: Mortality of diabetic patients after myocardial infarction remains high despite recent improvement in their management. This study population-based evaluates the impact of cardiovascular drug therapy on mortality within 28 days and during 5-year follow-up in diabetic compared with non-diabetic patients. METHODS: Using the MONICA Augsburg register from 1985 to 1992, 2210 inpatients with incident Q-wave myocardial infarction aged 25-74 years were included, of whom 468 had diabetes. Primary end point was mortality within 28 days and over 5 years. General linear model procedures were used for age-adjustment, controlling for sex, and testing significance; hazard risk ratios were calculated using multivariable Cox proportional hazards model procedures. RESULTS: During the 5-year follow-up, 598 subjects died (396 diabetic, 202 non-diabetic). The mortality rate within 28 days was 12.6% in diabetic patients (women 18.0%, men 9.9%) and 7.3% in non-diabetic patients (p = 0.001). Mortality in diabetic patients over 5 years was increased by 64% (95% confidence interval 1.39-1.95) compared with non-diabetic patients. This was considerably reduced (p < 0.001) in patients treated with thrombolytic drugs (risk ratio: diabetes 0.57, no diabetes 0.65) and with beta blockers (0.62 and 0.64) and antiplatelets (0.76 and 0.74) at hospital discharge. Mortality of diabetic patients treated with these drugs was reduced to that of non-diabetic patients without such treatment (risk ratio 1.01 to 1.27; p > 0.1). CONCLUSION/INTERPRETATION: Diabetic patients after myocardial infarction are at particularly high risk of dying, but benefit clearly from treatment with thrombolytics, beta blockers and antiplatelets. This study does not, however, allow any inferences to be drawn for treatment with angiotensin converting enzyme inhibitors or the impact of left ventricular function.

Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project.

The 10-year follow-up of the Munich General Practitioner Project was designed as a long-term prospective study to evaluate factors predicting macrovascular and overall mortality in a random cohort of non-insulin-dependent diabetic (NIDDM) patients. Of the original 290 patients (103 males, 187 females, median age 65 years) 92.5% could be assessed, 103 subjects had died, 58 from macrovascular causes. In an univariate analysis of baseline data, deceased patients, and especially those who died from macrovascular causes had significantly higher fasting blood glucose, HbA1c, von Willebrand-factor protein, urine albumin excretion, and serum beta 2-microglobulin, were significantly older, exhibited significantly more ischaemic heart disease (abnormal ECG Minnesota codes), carotid artery and peripheral vascular disease (both determined by ultrasound-Doppler), and had significantly inferior knowledge about diabetes and its treatment. No significant differences were seen for gender, blood pressure, smoking, total cholesterol, triglycerides, HDL-cholesterol, or the use of antidiabetic, antihypertensive or coronary drugs. In a multiple logistic regression analysis, the risk factors for macrovascular death were age, HbA1c and von Willebrand-factor protein. When baseline macrovascular disease was taken into account, carotid artery disease was also a determinant. The main variables from the metabolic syndrome (blood pressure, dyslipidaemia, body mass index) did not enter a multiple logistic regression analysis. The data suggest that age and haemoglobin A1c are major determinants, and that in addition von Willebrand-factor associated endothelial damage is a risk factor for macrovascular mortality in NIDDM patients.

Long-term survival after myocardial infarction: relationship with thrombolysis and discharge medication. Results of the Augsburg Myocardial Infarction Follow-up Study 1985 to 1993.

A large number of randomized clinical trials have shown that thrombolysis, long-term treatment with beta-blockers, antiplatelet drugs, and angiotensin converting enzyme inhibitors improve survival after acute myocardial infarction (AMI). However, for calcium channel blockers (nifedipine, diltiazem, and verapamil) there was either no benefit, or positive effects have been reported in subgroups only. Recent studies have raised concern about the safety of this drug class, especially in patients with coronary heart disease. We studied the long-term survival, for a median follow-up time of 4.4 years, of 1197 non-diabetic patients in the population-based AMI registry in Augsburg, Germany, aged 25-74 years, who had survived a first Q wave acute myocardial infarction for at least 28 days. The impact of thrombolysis and prescribed medication at discharge (beta-blockers, antiplatelet drugs, and calcium channel blockers) on long-term survival was analysed using the Cox-Proportional-Hazard model, controlling for age, sex, and concomitant cardiac drug use. Thrombolysis (risk ratio, RR, 0.72; 95% confidence interval, CI, 0.48-1.08), long-term beta-blockade (RR 0.52; 95% CI 0.36-0.74) and antiplatelet drug use (RR 0.69; 95% CI 0.50-0.94) were associated with considerable reductions in total mortality. The use of calcium channel blockers was not associated with a reduction in total mortality (RR 1.23; 95% CI 0.89-1.69). Separate analyses for nifedipine (RR 1.00; 95% CI 0.68-1.48), and diltiazem (RR 1.55; 95% CI 1.04-2.32) showed an increased risk of death associated with the latter. Using patients on beta-blockers only (RR 1.00) as a reference, the prescription of these calcium channel blockers was consistently associated with an increased total mortality (nifedipine, without beta-blockers RR 1.20; 95% CI 1.12-3.57, diltiazem, without beta-blockers RR 2.87; 95% CI 1.75-4.70). These results from an observational study demonstrate a benefit of thrombolysis, beta-adrenergic blockade and antiplatelet drug use on long-term survival in acute myocardial infarction patients. Calcium channel blocker use appears to be associated with an increased risk of death. These data support the need for controlled trials to address this issue specifically.

Rates of DNA-mediated electron transfer between metallointercalators.

Ultrafast emission and absorption spectroscopies were used to measure the kinetics of DNA-mediated electron transfer reactions between metal complexes intercalated into DNA. In the presence of rhodium(III) acceptor, a substantial fraction of photoexcited donor exhibits fast oxidative quenching (>3 x 10(10) per second). Transient-absorption experiments indicate that, for a series of donors, the majority of back electron transfer is also very fast (approximately 10(10) per second). This rate is independent of the loading of acceptors on the helix, but is sensitive to sequence and pi stacking. The cooperative binding of donor and acceptor is considered unlikely on the basis of structural models and DNA photocleavage studies of binding. These data show that the DNA double helix differs significantly from proteins as a bridge for electron transfer.

[Temporal trends in myocardial infarct morbidity, mortality and 28-day fatalities and medical management. Results of the Augsburg Myocardial Infarct Register 1985 to 1992]. / Zeitliche Trends von Herzinfarktmorbidität, -mortalität, 28-Tage-Letalität und medizinischer Versorgung. Ergebnisse des Augsburger Herzinfarktregisters von 1985 bis 1992.

Between 1985 and 1992 a significant decrease in rates of acute myocardial infarction (AMI; fatal and non fatal, including prehospital cardiac death) from 533 cases per 100,000 population of 455 cases was observed in the 25- to 74-year-old male study population (linear regression model: -13%, p < 0.01). In the corresponding female study population the AMI rate increased from 153 cases per 100,000 population in 1985 to 153 cases in 1992 (linear regression model: +18%, p < 0.05). The decrease was only in 50- to 59-year-old male AMI patients without changes in risk factors (smoking, diabetes, hypertension, recurrent AMI) but with a decrease in patients with a history of angina pectoris, which may have been caused by intensified medical treatment of AMI endangered patients. Over time 34% of the patients died before hospitalization and another 19% died within the first 24 h after hospitalization. The register results show an underestimation of the coronary mortality by the official cause of death statistics. In contrast, the significant increase in treatment with thrombolytics (men from 16% to 38%, women from 8% to 42%), beta-blockers (men from 48% to 69%, women from 45% to 71%), and antiplatelets (men from 55% to 94%, women from 52% to 91%) was not related to any significant changes in 28-day case fatality of the 24-h survivors (men and women 13% to 14%). Without media campaigns, for the increased number of cases hospitalized within 4 h after the event (1985-1987 men 50%, women 42%; 1990-1992 58% and 60%; p < 0.01) thrombolytic treatment shows an increase from 25% in men and 17% in women (1985-1987) to 54% in men and 47% in women (1990-1992; p < 0.01).

Weekly variation of acute myocardial infarction. Increased Monday risk in the working population.

BACKGROUND: Seasonal and circadian variations in the occurrence of myocardial infarction and sudden cardiac death have been documented, suggesting that triggering factors may play a role in the causation of cardiac events. However, there are only sparse and conflicting data on the weekly distribution of the disorders. METHODS AND RESULTS: To determine the weekly variation of acute myocardial infarction and sudden cardiac death, 5596 consecutive patients (71% men; age, 63 +/- 1 years) were analyzed in a regionally defined population (n = 330,000; age, 25 to 74 years) monitored from 1985 to 1990. The exact time of onset of symptoms was used to determine the day of the event. Patients with myocardial infarction (n = 2636) demonstrated a significant weekly variation (P < .01) with a peak on Monday, whereas patients with sudden cardiac death (n = 2960) were evenly distributed throughout the week. A similar weekly pattern was observed in subgroups of patients with myocardial infarction defined with respect to age, sex, cardiac risk factors, prior cardiac medication, and infarct characteristics. The working population demonstrated a weekly variation of myocardial infarction as opposed to the nonworking population, with a 33% increase in relative risk of disease onset on Monday (P < .05) and a trough on Sunday compared with the expected number of cases, if homogeneity was assumed. CONCLUSIONS: The onset of acute myocardial infarction demonstrates a peak on Monday primarily in the working population. If this finding is confirmed in other communities, it may aid in identifying acute triggering events of myocardial infarction and perhaps in improving prevention of the disease.

[Drug treatment of patients with heart infarcts before and after the acute stage: results of the Heart Infarct Registry Augsburg]. / Die Arzneimittelbehandlung von Herzinfarkt-patienten vor und nach dem Akutereignis: Ergebnisse des Herzinfarktregisters Augsburg.

To assess the changes in medications prescribed before and after acute myocardial infarction (AMI), all surviving patients aged 25-74 years registered from 1985-1988 in the Coronary Event Register Augsburg were evaluated by sex, medical history, and drug use before and after the event. For the 1546 hospitalized patients (1181 men, 365 women) utilization of all drug groups is higher for patients with reinfarction than for patients with first-ever AMI. Before AMI, but not on hospital discharge, women received significantly more medications than men and were more frequently treated with diuretics (30%; men 18%), antihypertensive drugs (15%, men 8%) and cardiac glycosides (20%; men 14%). The most frequently used drug groups are nitrates (before AMI: 30%; after AMI: 80%) and calcium antagonists (before AMI: 26%; after AMI 61%). The four years show a significant increase in patients with reinfarction who were treated with platelet aggregation inhibitors (1985: 9%; 1988: 32%), as well as an increase in AMI patients released from hospital with this medication (1985: 38%; 1988: 64%). A concomitant significant decrease in reinfarction rates for men is found in the course of the four years under study. The results indicate a rapid assimilation of the results of clinical trials in practice down to the substance level.

Quantitative analysis of platelet function using stagnation point flow aggregometry. First clinical results.

BACKGROUND: The clinical consequences of atherosclerosis result from vascular occlusion. The central role of platelet-vessel wall interaction in the initiation and perpetuation of this process is well established. Individual analysis and quantification of two major platelet functions underlying atherosclerosis and thrombosis, i.e. adhesion (platelet-wall interaction) and aggregation (platelet-platelet interaction), would contribute significantly towards elucidation of the mechanisms involved and therefore towards optimization of prophylaxis and therapy. The Stagnation-Point-Flow-Adhesio-Aggregometer (SPAA), in which such an evaluation of platelet function is possible, was thus standardized and its clinical reproducibility and predictive power assessed. METHODS: Using the SPAA, a morphometric separation of adhesion and aggregation is obtained via dark field micrographs of platelet microthrombi formed during stagnation point flow of platelet rich plasma (PRP). Quantification is achieved via biomathematical evaluation of simultaneously obtained growth curves, whereby the degree of adhesivity and aggregability is reflected in the respective growth rate constants Kpw (%) and Kpp (%). Experiments with the PRP of 36 healthy volunteers were performed and the results compared to those obtained for 32 patients exhibiting angiographically verified peripheral arterial disease (PAD). RESULTS: The control group exhibited values (Kpw) ranging from 0.40% to 1.10% (average Kpw: 0.71 +/- 0.21%). Differences in average Kpw value between the control subgroup over and that under 45 years of age were absent. A spontaneous platelet aggregation was not observed in the controls (Kpp = 0%). The overall intraindividual Kpw variation in 18 volunteers examined 3 times or more ranged from a minimum of 3% to a maximum of 20% of respective Kpw value. The patients were divided into two subgroups: diabetics and nondiabetics. The nondiabetic group demonstrated an average Kpw of 1.56%. In addition, a spontaneous aggregation was observed in 50% of all experiments (average Kpp = 1.42%). The diabetic group exhibited the highest average adhesion value (Kpw = 1.94%) occurrence of spontaneous aggregation in all experiments (Kpp = 2.10%). CONCLUSION: The consistency in adhesion values obtained among the controls as well as the minimal intraindividual variance observed, demonstrates the reproducibility of the method. The statistically significant increase (p < 0.001) in adhesivity of patients as compared to controls, as well as the common occurrence of spontaneous aggregation can therefore be considered a pathologic platelet response reflecting the severity of the disease. Results obtained verify the presence of circulating hyperreactive platelets in PAD patient and indicate the predictive power of the method. Thus the SPAA may be of considerable aid in improving thrombosis prophylaxis and therapy.

[Prognostic significance of prehospital phase in acute myocardial infarct. Results of the Augsburg Myocardial Infarct Registry, 1985-1988]. / Prognostische Bedeutung der Prähospitalphase beim akuten Myokardinfarkt. Ergebnisse des Augsburger Herzinfarktregisters 1985-1988.

Data collected by the Augsburg Infarct Register during 1985-1988 were analysed. There were 3,729 cases of acute myocardial infarct (2,672 men and 1,057 women; mean age 62.8 [25-74] years). Before hospitalization cardiac arrest had occurred in 1,401 persons (38%); resuscitation attempts were made in 494 of them (34%). A doctor witnessed the arrest in 243 persons, 13 of whom survived the subsequent 28 days. But none of 640 persons who had a cardiac arrest when only lay people were present survived the first day: resuscitation had been attempted in 39. 518 persons died before hospitalization without anyone present. In the first hour after infarction 30% died, within 4 hours 38% of the total group. The median pre-hospitalization time was 3.11 (range 1.67-8.05) hours. 42% of the patients first called their doctor, 26% went to him (her). This caused decisive delays. The thrombolysis rate was 24%, if the pre-hospital interval was under 6 hours (mortality rate 6% with, 12% without thrombolysis). The prognosis of acute myocardial infarction could be improved by specific instructions to high-risk patients and their relatives and by widening emergency care provisions.

Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study.

The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed.

[Drug interactions in the prescriptions of patients before and after a heart infarct: results of the MONICA Augsburg heart infarct registry]. / Arzneimittelwechselwirkungen in den Verordnungen von Patienten vor und nach dem Herzinfarkt: Resultate des MONICA Augsburg Herzinfarktregisters.

The prescriptions of 603 patients who had survived acute myocardial infarction (AMI) for at least one year and were registered from 1 Oct 84 to 31 Dec 86 in the Coronary Event Register of the MONICA project Augsburg were analyzed for the presence of drug-drug interactions with the aid of a computerized drug information system (SMA). Prior to AMI, 59% of patients were treated (average of 2 active substance per patient), 100% were treated on release from hospital (4.5 active substances), and 96% one year after AMI (5.8 active substances). Potential drug-drug interactions were found in 18% of patients before AMI, 65% on discharge from hospital, and 66% one year after AMI. While the potential frequency and severity of interactions are minor on average, prescriptions frequently contain several interactions. Calculations show that at least 5-6% of all prescriptions after AMI will produce interactions, so that drug safety for this high-risk patient group can be enhanced by a drug information system. Beta-blockers are the substance group most frequently involved in potential interactions in AMI patients.

[Thrombolysis therapy and coronary angiography in acute myocardial infarct in the Augsburg region: results of the Augsburger Heart infarct register 1985-1987]. / Thrombolysetherapie und Koronarangiographie bei akutem Myokardinfarkt in der Region Augsburg: Ergebnisse des Augsburger Herzinfarktregisters 1985-1987.

In the years 1985-87, the Augsburg Coronary Event Register registered 1333 hospitalized patients who had survived an acute myocardial infarction (AMI) for at least 24 h. In 953 patients, data on time intervals in the prehospital phase were documented in addition to the medical records data in a standardized nurse interview. The time from onset of AMI until the patient called for medical attention constituted most of the prehospital time delay. Of the interviewed male and female patients, 67% were hospitalized within 6 h (= time limit). The differences, both in the number of thrombolyses and the number of coronary angiographies performed in men and in women are statistically significant. Thrombolysis was performed in 27% of the male and 12% of the female AMI patients who were admitted to hospital within the time limit. The rate of thrombolytic therapy decreased with increasing age and was less in patients with recurrent AMI (men: 20%, women: 0%) than in patients with first AMI (men: 29%, women: 15%). There was some time-of-day variation in the percentage of thrombolytic therapy which may be attributable to hospital organization. From 1985 to 1987, the coronary angiography rates performed in the medical center doubled, independent of the thrombolytic therapy rates. In this time, angiography rates in thrombolyzed patients increased from 49% to 75%, and from 14% to 31% in patients without thrombolysis. The 28-day case fatality was 4.8% in patients with thrombolysis and 13% in patients without thrombolytic therapy. Controlling for age, sex, and recurrent AMI, this difference is not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Morbidity and mortality of myocardial infarction in the Augsburg MONICA study area in 1985, 1986 and 1987.

In the years 1985, 1986 and 1987, the MONICA Augsburg Coronary Event Register recorded 1488 coronary events (1214 men and 274 women) occurring in 35-64 year old residents of the study region (population: 102,000 men and 105,000 women). The rates presented include all coronary events with a definite acute myocardial infarct (AMI), possible AMI, resuscitated cardiac arrest, and insufficient data. The age-standardized attack rates in men are 390 (1985) to 372 (1987) and in women 51 (1985) to 72 (1987) per 100,000 population. The age-standardized 28-day case fatalities in men are 44 (1985) to 44 (1987) and in women 67 (1985) to 55 (1987) per 100 coronary events. With the exception of the attack rates in women, no statistically significant differences between yearly rates could be established.

[The myocardial infarct status of a South German population: results of the Augsburg myocardial infarct register l985]. / Zur Herzinfarktsituation in einer süddeutschen Bevölkerung: Ergebnisse des Augsburger Herzinfarktregisters 1985.

The Augsburg Myocardial Infarction Register recorded in 1985, 999 coronary events (734 men, 265 women) occurring in 25-74-year-old residents of the city of Augsburg and the counties of Augsburg and Aichach-Friedberg (study population: 156,489 men and 171,093 women). On average, 444 men and 138 women per 100,000 of the population suffered an acute myocardial infarction (AMI) in 1985. The risk of morbidity increased with age in both men and women, but gained significance for women only after their 55th year of life. The 28-day case fatality was 54% for male AMI cases and 66% for females; 34% of the AMI patients died without ever reaching a hospital. Cardiopulmonary resuscitation (CPR) was attempted by a physician in one-in-three of these out-of-hospital deaths. Although one of two out-of-hospital deaths occurred in the presence of a medical lay person; lay CPR was the exception. Broader population education in CPR techniques may thus constitute one method of reducing the number of early AMI deaths. The median prehospital time for interviewed hospital patients (66%) was 5 h, and approximately 2 h for patients with systemic thrombolysis (n = 71). The combination of fatal coronary events from the official cause-of-death statistics and the results from the Augsburg register were used to estimate AMI morbidity for the whole of the FRG in 1985. This leads to an expected morbidity of 210,000 AMI, of which 141,000 AMI will be fatal (both sexes).