Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986–92: the FINMONICA Myocardial Infarction Register Study

Abstract

Miettinen H, Salomaa V, Ketonen M, Niemelä M, Immonen‐Räihä P, Mähönen M, of the FINMONICA Myocardial Infarction Register Group (Kuopio University Hospital, Kuopio; National Public Health Institute, Helsinki; North Karelia Central Hospital, Joensuu; Loimaa District Hospital, Loimaa; and Turku University Hospital, Turku, Finland). Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986–92: the FINMONICA Myocardial Infarction Register Study. J Intern Med 1999; 245: 11–20. Objectives. To investigate changes in the medical treatment of patients with myocardial infarction and the trends in revascularization procedures in Finland. Design. A population‐based myocardial infarction (MI) register study. Setting. Populations, aged 25–64 years, of the three geographical areas of Finland, provinces of North Karelia and Kuopio in eastern Finland and the Turku‐Loimaa area in south‐western Finland. Main outcome measures. Medical treatment administered prior to the coronary event, during the hospitalization and at discharge from hospital to all patients hospitalized due to suspected myocardial infarction and all CAD deaths occurring during three separate 4‐month periods in 1986, 1989 and 1992. Data on coronary bypass surgery and percutaneous coronary angioplasty in the study areas for 1986–92. Results. The most marked change in the medical treatment of hospitalized myocardial infarction patients was the significant increase in the use of thrombolytic treatment (5% of patients in 1986 and 24% in 1992, P < 0.001 for trend). The use of antiplatelet agents increased from 1986 to 1992 prior to the coronary event, during the hospitalization and at discharge. The use of beta‐blockers and intravenous nitrates increased and the use of calcium‐channel blockers declined significantly in hospitalized patients during the study period. Hospitalized male myocardial infarction patients were treated more often with beta‐blockers, nitrates, antiplatelet agents and thrombolytic agents than female patients, suggesting less intensive medical treatment in women. Conclusion. The results of the large clinical trials regarding the medical treatment of myocardial infarction patients were adopted in the clinical practice rapidly and the treatment of myocardial infarction patients and the number of revascularization procedures changed markedly from 1986 to 1992 in Finland. These changes may in part explain the favourable changes in mortality from CAD in Finland.