Between 2012 and 2015 in Estonia, the management of AMI shifted towards increased use of primary PCI and ticagrelor, with relatively stable overall mortality.
Describes national AMI care patterns in Estonia; leaves open questions on trends, quality gaps, and targeted interventions.
Introduction: The Estonian Myocardial Infarction Registry (EMIR) has been founded in 2012 to improve the diagnostics and treatment of acute myocardial infarction (AMI) and to conduct epidemiological research. Purpose: To describe the baseline characteristics, treatment and mortality of Estonian AMI patients hospitalized during 2012–2015. Material and methods: EMIR collects data on all hospitalized AMI cases in Estonia (ICD 10th version, codes I21-I22); submitting the data online via a specific form is mandatory. The use of personal identification number enables the linkage of EMIR data with other national registries. EMIR collects the following data: patient demographics and medical history, data about current AMI, time points commonly used as quality indicators, diagnostic and treatment methods (incl. medicines), in-hospital adverse events and mortality. Results: During the years 2012–2015 more than 95% of the hospitalized cases were submitted to EMIR. The mean age (72 years), proportion of males (58%) and patients with ST-segment elevation AMI (STEMI, 43%) remained stable. We observed a high rate of patients with diabetes mellitus (25%), hypertension (78%) and dyslipidaemia (57%). In addition, 26% of patients were current smokers and 25% reported previous AMI. The prescription of betablockers, ACEI/ARB and statins showed no major change and remained above 75% during the years studied. The use of P2Y12 inhibitors increased from 66% to 72%, mainly derived from increased utilization of ticagrelor – it was used in 47% of patients in 2015. The rate of patients undergoing percutaneous coronary intervention was quite similar – 55% in 2012, 59% in 2013 and 57% in 2014 and 2015. Among STEMI patients the use of thrombolysis decreased from 15% to 10% (p<0.01) and the use of primary PCI increased from 44% to 49% (p<0.05). The mortality rates have remained relatively stable through the study period except for year 2014 where we observed a lower in-hospital mortality compared to both 2013 and 2015 (Table 1).
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Veldre et al. (2017) studied this question.
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