Analysis of the Evolution of the AMI in the Past 14 Years in Argentina. Therapeutics Indications

pp. 591-601

Abstract

Objective

Analysis of evolution of different therapeutic approaches, delay of admission and mortality due to AMI during the past 14 years in Argentina.

Material and method
The four SAC (Argentine Society of Cardiology) surveys performed between 1987 and 2000 included 1778 AMI patients (pts) admitted to 191 coronary care units nationwide. Each survery was performed along a 30 day period in four different years: 1987 (309 pts), 1991 (526 pts), 1996 (645 pts) and 2000 (208 pts).

Results

The pooled analysis of the four surveys revealed a significant reduction in the incidence of Q- wave infarction (83% in 1987 vs. 73% in 2000; p = 0.001). On the other hand, the percentage of admissions in the first six hours of AMI remained essentially the same (70% in 1987 vs. 72% in 2000). The use of thrombolytics (TL) was reduced from 1996 to 2000 (41% vs. 33%) whereas the usage of
primary angioplasty (PTCA) doubled (8% vs. 17%; p < 0.0001). Employment of reperfusion strategies (TL or PTCA) within 6 hrs of symptom onset rose significantly until 1996 and remained stable thereafter (around 60%) with a higher use
of PTCA. A significant increase in the use of reperfusion strategies was observed within the 7- 12 hrs interval between 1987 and 2000 (7.5% in 1987 vs. 46% in 2000; p < 0.01). Overall mortality was similar in the four surveys (12% in 1987 vs. 11% in 2000) and remained without variations after adjusting for possible confounding variables such as age, gender, or Killip class > 1 at admission. In the 2000 survey, mortality rates were comparable for pts treated with TL or PTCA (9% vs. 8%, respectively).

Conclusions

The four SAC surveys carried out within the past fourteen years provided us with valuable information concerning demographic variables of AMI patients and management of infarction in Argentina. Several changes in AMI therapies were observed according to the information obtained from randomized trials: a greater use of beta-blockers and ACE inhibitors and a lower use of calcium blockers. In the 2000 survey reperfusion strategies shifted to a greater use of primary angioplasty.