[Therapy of acute myocardial infarct (1994-1996) at non-university hospitals in Switzerland (CHAMI Study)]. / Die Therapie des akuten Herzinfarkts (1994-1996) an nicht-universitären Spitälern in der Schweiz (CHAMI-Studie).

The CHAMI study (Confederatio Helvetica Acute Myocardial Infarction) recorded the therapies administered for acute myocardial infarction in 520 consecutive patients between October 1994 and February 1996 at 10 non-academic hospitals in Switzerland. The patients in this group consisted of 363 men and 157 women with an average age of 63.2 years. The prescribed medications administered from the day of hospital admission until the day of discharge were recorded. In the acute phase, the patients were given the following therapy: thrombolytic agents 40%, i.v. nitrates 65%, i.v. beta-blockers 22%, aspirin 95%, oral beta-blockers 36%, ACE inhibitors 14%. Impressive was the lower distribution of thrombolytic agents and beta-blockers among the older patients (age > 70) (thrombolytic agents 52.1% vs 28.4%; oral beta-blockers 44.0% vs 29.1%) and in particular among women (thrombolytic agents 26.8% vs 46%; oral beta-blockers 29.3% vs 39.7%) in men. Therapy at hospital discharge consisted, inter alia, of aspirin (73%), beta-blockers (54%), ACE inhibitors (3%), and lipid lowering agents (10%). The hospital mortality was 12.6%. The CHAMI study provided the participating hospitals with a quality control comparison with other participating centers and impressively demonstrated with the example of the lipid lowering agents, that the significance of secondary prophylaxis is assigned too little importance in contrast to acute therapy.

[Prinzmetal phenomenon and a rare coronary anomaly as infarct and death cause of a 45-year-old patient]. / Prinzmetal-Phänomen und seltene Koronaranomalie als Infarkt- und Todesursache einer 45jährigen Patientin.

We report about the sudden death of a 45-year-old woman with anomalous origin of both coronary arteries from a single ostium in the right sinus of Valsalva, the left coronary artery running between the aorta and the pulmonary trunk. The clinical picture was that of Prinzmetal's form of variant angina, and it preceded death of inferior myocardial infarction. Coronary spasm and the anatomical anomaly were demonstrated by coronary angiography. There was no atheromatous plaque or other obstructive lesion in the dominant right coronary artery which could have explained the inferior myocardial infarction seen at autopsy. This is the first detailed report in which this rare coronary anomaly has been associated with Prinzmetal's variant angina. The demonstration of spasm in the dominant coronary artery and of an infarct in that part of the myocardium supplied by it in the absence of any anatomical obstruction suggests that this patient's death resulted from coronary spasm.