Comparison Of 30-Day Outcome In St-Elevation Myocardial Infarction Patients Treated In Sweden Or Hungary: Results From Swedeheart And The Hungarian Myocardial Infarction Registry

Purpose: International comparisons are important to understand the effect of whole systems of care on quality and outcome. The aim was to compare case-mix, treatments and outcome for ST-elevation myocardial infarction (STEMI) patients who are treated in Hungary or Sweden. Methods: All patients with STEMI registered in the Hungarian myocardial infarction (MI) registry (n=4846), were compared to the nationwide Swedish MI registry SWEDEHEART (n=8668) between 1 January 2010 – 31 December 2011. The Hungarian registry consists of 37 voluntarily participating centers that capture 28.6% of all MI patients in the country, whereas the Swedish database has near complete coverage. We compared 30-day mortality between the countries, accounting for baseline characteristics using a propensity score-adjusted logistic regression with multiple imputation for missing covariates. Results: There were substantial differences in baseline characteristics between the two countries (table), with the Hungarian STEMI patients being younger and having more cardiovascular risk factors. More patients in Sweden received thrombolysis (5.4% versus 1.5%) or underwent primary PCI/subsequent coronary angiogram (91.2% versus 84.2%). The 30-day mortality was lower in Sweden than in Hungary (7.9% versus 9.5%; odds ratio 0.81, 95% confidence interval 0.72 to 0.93). Differences in baseline characteristics did not fully explain this difference; 30-day mortality was slightly lower in Sweden also in the adjusted models (odds ratio 0.86, 0.75 to 0.99). Characteristics/Therapies: STEMI patient Conclusion: When the Hungarian MI registry was compared with SWEDEHEART, the Hungarian STEMI patients were younger, had more risk factors and a higher 30-day mortality compared to Sweden. The differences in case-mix did not fully explain the differences in 30-day mortality.