[Non-ST-elevation infarction, the stepchild of interventional myocardial salvage: experience of a single institute]. / Nem ST-elevációs infarktus ­ az intervenciós szívizommentés mostohagyereke.

INTRODUCTION: The diagnosis of acute myocardial infarction is based on ECG abnormalities besides to chest pain and dyspnea. It is caused by myocardial hypoperfusion, in most patients due to severe coronary artery narrowing or occlusion, but it can also occur without visible coronary artery changes. The non-ST-elevation form (NSTEMI) is usually associated with less complaints compared to the ST-elevation form (STEMI), the ECG changes are not so typical, so its recognition is more difficult in the early stage. Possibility of myocardial cell damage reduction is the restoration of perfusion with coronary intervention. OBJECTIVE: To investigate how much time elapses in acute NSTEMI from the onset of the complaint to the opening of the coronary vasodilator balloon. METHOD: From 3733 acute coronary interventions performed in NSTEMI between 01. 01. 2016 and 12. 31. 2020, in 1376 patients who underwent percutaneous intervention for the first time, the onset of the complaints, the date of the first medical contact and opening of the balloon, as well as the 30-day or 1-year mortality were known. The median values of the time differences and the mortality data were compared with the similar data of 1718 STEMI patients of this period. The median times were given in hours:minutes, incidence in percent, a two-sample t-test was calculated for the comparison of mortality data. RESULTS: In NSTEMI, the median time between the first medical contact (5:35 vs. 2:05 h:min) and PTCA balloon opening (18:12 vs. 4:05 h:min) was longer compared to the onset of the complaint as in STEMI. Within 2 hours, 21.3% of NSTEMI patients reached the first medical contact and 1.2% had the PTCA balloon opened, in STEMI this ratios were 48.7% and 11.7%. Within 4 hours, these were in NSTEMI 36.3% and 6.1%, in STEMI 64.1% and 46.8%. The 30-day mortality rate in NSTEMI was lower than in STEMI (5.9% vs. 7.9%, p = 0.03), the 1-year rate was higher (16.1% vs. 12.5%, p = 0.004). In 554 primarily admitted patients who met the study criteria, the median P-B time intervals were shorter (10:55 h:min), the mortality data showed a mild but statistically insignificant difference (5.6% at 30 days, 13.9% at 1 year). CONCLUSION: Based on the 1-year mortality data, NSTEMI cannot be considered less harmful compared to STEMI. After the onset of hypoperfusion, myocardium necrosis proportional to the elapsed time increases the likelihood of subsequent heart failure. For this reason, it seems advisable for patients to reach the intervention center earlier than at present due to the invasive diagnostic and therapeutic options. Orv Hetil. 2023; 164(47): 1865-1870.

Primary coronary intervention in ST-elevation myocardial infarction / Primer coronariaintervenció ST-elevációs infarktusban.

Összefoglaló. Bevezetés: Heveny myocardialis infarctusban a szívizommentés sikere, a beteg életkilátása nagymértékben függ a panasz kezdete és az elzáródott koszorúér rekanalizálása között eltelt ischaemiás idotol. Jelenleg az ér nyitása optimális esetben minden betegnél koszorúér-intervencióval történik. Célkituzés: Annak vizsgálata, hogy öt év alatt mennyit változtak az ischaemiás ido összetevoi, és miben változott az elzáródott ér nyitásának módszere ST-elevációs myocardialis infarctus (STEMI) miatt végzett primer coronariaintervencióban. Módszer: 2014. 01. 01. és 2018. 12. 31. között 1663, STEMI miatt koszorúér-intervencióval kezelt betegnél (1173 férfi és 490 no) vizsgáltuk évenkénti bontásban a panasztól a koszorúér nyitásáig eltelt ido összetevoit és a 30 napos halálozást. Eredmények: Öt év alatt a panasztól az elso egészségügyi kontaktusig medián 2:53 vs. 2:10 óra (p = 0,0132), ettol az intervenciós centrumba történt felvételig medián 1:17 vs. 1:03 óra (p = 0,009), a felvételtol a ballon nyitásáig medián 0:31 vs. 0:29 óra (p = ns) telt el. A panasztól a ballon nyitásáig eltelt ido (medián 5:29 vs. 4:07 óra, p = 0,0001) rövidült, döntoen 2014 és 2015 között. A gyógyszerkibocsátó stent beültetése 15%-ról 96%-ra nott. A vizsgált években a légzés/keringés támogatás aránya 8,2-10,6-13,9-7,6-8,4, a 30 napos halálozásé 4,1-6,8-11,1-7,4-5,7% volt; a két érték korrelációt mutat (p = 0,827). Következtetés: Öt év alatt a panasztól az elso egészségügyi kontaktusig és a kórházi beszállításig eltelt ido rövidült, de az Európai Kardiológiai Társaság ajánlásához képest hosszú; a kórházi felvételtol a ballon nyitásáig eltelt ido megfelelo. A négy órán belüli reperfúzió a betegek közel felében valósult meg. Az intervenciós centrumba való gyorsabb bekerülés javíthatna az eredményen. Orv Hetil. 2021; 162(13): 497-503. INTRODUCTION: In acute myocardial infarction, the heart muscle salvage, the patient's life expectancy is highly dependent on the elapsed ischaemic time from the onset of complaint to target vessel recanalisation. Nowadays, target vessel recanalisation is performed with coronary intervention in all patients in optimal case. OBJECTIVE: To examine how the components of ischemic time and the opening procedure of the occluded coronary have changed over five years in primary intervention done in acute ST-elevation myocardial infarction (STEMI). METHOD: Authors studied data of 1663 (1173 male and 480 female) STEMI patients in annual breakdowns treated with coronary intervention between 01. 01. 2014 and 31. 12. 2018, time from complaint to coronary artery opening, details of intervention and 30 days mortality rate. RESULTS: During the five years, time intervals were as follows: from onset of complaint to first medical contact: median 2:53 vs. 2:10 hours (p = 0.0132), from this to admission in the interventional centre: median 1:17 vs. 1:03 hours (p = 0.009), from hospital admission to balloon opening: median 0:31 vs. 0:29 hours (p = ns). In total, the complaint to balloon opening time (median 5:29 vs. 4:07 hours, p = 0.0001) diminished, decisively from 2014 to 2015. Ratio of drug-eluting stent implantation increased from 15% to 96%. In the investigated years, the need of respiratory and/or circulatory device support ratio was 8.2-10.6-13.9-7.6-8.4, 30-day mortality rate between 4.1-6.8-11.1-7.4-5.7%; these two values showed a correlation (p = 0.827). CONCLUSION: The time from complaint to first medical contact and transfer to hospital against the significant decrease is still longer than the recommendation of the European Society of Cardiology. The time from hospital admission to balloon opening is adequate. Reperfusion within four hours was achieved in half of the patients in total. Faster hospitalization may improve results. Orv Hetil. 2021; 162(13): 497-503.

Quality assurance of national internet-based patient register data: Experiences during the operation of the Hungarian Myocardial Infarction Registry, 2010­2020 / Internetalapú, országos betegségregiszter adatainak minoségbiztosítása: Tapasztalatok a Nemzeti Szívinfarktus Regiszter muködtetése során, 2010­2020

Összefoglaló. Bevezetés: A Nemzeti Szívinfarktus Regiszterben 111 788 beteg 122 351 infarktusos eseményéhez kapcsolódó 145 292 kezelés adatai szerepelnek. Módszer: A rögzített adatokat az üzemeltetok folyamatosan kontrollálják, bemutatják azokat a minoségbiztosítási módszereket, amelyekkel az adatbázis teljességét és megfeleloségét biztosítják. Az online informatikai rendszerben az adatbevitel során 119 automatikus ellenorzési algoritmust muködtetnek. Az automatikus ellenorzési algoritmussal nem kezelheto adatok ellenorzését 5 részállású, egészségügyi képzettségu kontroller és 2 foállású munkatárs végzi. A regiszter muködése során folyamatosan fejlesztették az ellenorzés módszereit, ennek során 2018-tól a kontrollerek által ellenorzött adatlapok utóellenorzésére is sor kerül. Az utóellenorzés során a már ellenorzött adatlapok 2,4%-ában további javításra volt szükség. Eredmények: Az utóellenorzés eredménye, hogy a kontrolleri munkát hatékonyabbá sikerült tenni, mivel egyre kevesebb az utóellenorzés során hibásnak talált adatlapok száma. Megvizsgálták, hogy az adatlap kérdéseire milyen arányban kaptak értékelheto választ. Az értékelheto válaszok aránya a legtöbb esetben meghaladta a 90%-ot, azonban a panaszok kezdetének ideje az adatlapok 39%-ában volt megadva, míg a dohányzási szokásokkal kapcsolatos válasz az esetek 59%-ában volt megfelelo. Megbeszélés: A szerzok rámutatnak arra, hogy a Nemzeti Egészségbiztosítási Alapkezelo és a Nemzeti Szívinfarktus Regiszter adatbázisának folyamatos egyeztetése hozzájárul a regisztráció teljességének biztosításához, lehetové teszi a betegek állapotának hosszú távú követését. Miután a program kötelezo jelleguvé vált 2014. 01. 01-jén, az elso évben a szívinfarktus-diagnózissal finanszírozott betegek kétharmada (67%) szerepelt a regiszter adatbázisában; ez az arány a 2017-2019-es években meghaladta a 90%-ot (91,7-93,6-91,3%). Következtetés: Vizsgálatukból a szerzok azt a következtetést vonják le, hogy a betegségregiszter muködése során szükséges az adatok teljességének és megfeleloségének folyamatos ellenorzése. A regiszter adatbázisának 90% feletti teljessége az ellátórendszer minoségi paramétereinek folyamatos követését teszi lehetové. Orv Hetil. 2021; 162(2): 61-68. INTRODUCTION: The Hungarian Myocardial Infarction Registry contains data on 145 592 treatments related to the 111 788 patients and the 122 351 myocardial infarctions. METHOD: The recorded information is continuously monitored, and the quality assurance methods used to ensure the completeness and adequacy of the database are presented. In the online IT system, 119 automatic verification algorithms are operated during data entry. Data that cannot be handled by the automated verification algorithm is checked by five part-time health-qualified controllers and two full-time employees. During the operation of the register, the control methods were continuously developed, during which the data sheets checked by the controllers will be post-checked from 2018 onwards. During the post-checked process, 2.4% of the datasheets required further correction. RESULTS: The number of data sheets found to be incorrect during the post-audit was decreasing. The authors examined the proportion of evaluable answers to the questionnaire. The rate of evaluable responses was over 90% in most cases; however, the time of the onset of symptoms was given in 39% of the datasheets, while the answer to smoking habits was adequate in 59% of cases. DISCUSSION: The authors point out that the continuous consultation of the database of the National Health Fund Management Centre and the Hungarian Myocardial Infarction Registry contributes to ensuring the completeness of registration, enabling long-term monitoring of the condition of patients. In the first year of the mandatory period of the program, two-thirds (67%) of patients treated with a diagnosis of myocardial infarction were included in the registry database, and this proportion exceeded 90% in the years 2017-2019 (91.7-93.6-91.3%). CONCLUSION: The study of the authors concludes that the completeness and adequacy of the data need to be constantly monitored during the operation of the patient registry. The integrity of the register database above 90% enables the continuous monitoring of the quality parameters of the system. Orv Hetil. 2021; 162(2): 61-68.

[Clinical presentation and hospital outcome of patients with ST-elevation myocardial infarction -- Hungarian Myocardial Infarction Registry data]. / ST-elevációval járó myocardialis infarctus miatt kezelt betegek klinikai jellemzoi és kórházi prognózisa - Magyarországi Infarctus Regiszter.

INTRODUCTION: There are only very few data on gender differences in patients with ST-elevation myocardial infarction. AIM: To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. PATIENTS AND METHODS: Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. RESULTS: Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p<0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p<0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p<0.001). CONCLUSIONS: At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.

[Percutaneous coronary intervention without on-site cardiac surgery: the first one thousand patients]. / Percutan coronaria-intervenció kórházon belüli szívsebészet nélkül: az elso ezer beteg.

At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (700 male and 331 female, average age 59.8 +/- 15.1 years) between July 2000 and June 2002. The indications were: stable effort angina 679 (65.8%), unstable angina and non-ST elevation myocardial infarction 267 (26.0%), ST elevation myocardial infarction 85 (8.2%). Single vessel dilatation was performed on 906 (87.9%), double and triple vessel on 125 (12.1%) pts in 1170 vessels (1145 native, 24 saphenous vein and 1 mammary artery graft) and in 1372 stenoses. During the interventions, 1043 stents were implanted in 797 pts, average 1.3/pt. The intervention was clinically successful in 950 (92.1%) and unsuccessful in 81 (7.9%) pts. In most of cases, the lack of success was a result of ineffective recanalisation. 65 major adverse cardiac events occurred in 35 (3.4%) pts (acute redilatation 20 (1.9%), acute surgery 4 (0.4%), acute myocardial infarction 34 (3.3%) and fatal outcome 7 (0.7%). Fatal outcome occurred in the group of stable angina 1 (0.1%), in the group of unstable angina and non-ST elevation myocardial infarction 4 (1.5%), in the group of ST elevation myocardial infarction 2 (2.4%). Within one year, 228 (22.1%) repeated dilatations were performed because of chronic restenosis. The results suggest that the moderate risk interventions can be performed with satisfactory result and average risk even without in-hospital cardiac surgery. High-risk interventions are still to be performed in institutes without on-site surgery.