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Objective: Rates of coronary angiography (CA) after myocardial infarction (MI) vary widely between institutions. Furthermore, the indications for CA are often in conflict with recognized guidelines. The present study sought to determine the characteristics and the one-year mortality in patients with MI, regardless of age and hospital facilities, according to the use of CA after MI., Methods and Results: Data were prospectively collected in all patients with MI admitted to all hospitals in three departments in the Rhône-Alpes region. Among 2493 patients, 1117 (45%) underwent CA. In multivariate analysis, CA rate was lower with increasing age, female sex, in patients with comorbidity or heart failure. CA was performed in 49% of patients admitted to hospitals with on-site CA vs. 32% in hospitals without on-site CA (OR: 3.54, after adjustment for patients' characteristics). One-year mortality rate was 6.5% for the CA group and 36.9% for the no-CA group. In multivariate analysis, age, history of angina pectoris, presence of Q waves, Killip class at admission II, III, or IV and CPK ratio > or = 9 were significant predictors of a higher one-year mortality, but performance of CA did not significantly influence it: RR: 0.79 (95% CI 0.58 to 1.07)., Conclusions: Among patients with MI in a large unselected cohort in a French region, the one-year mortality was significantly lower in those referred for angiography. However, after correction for the confounding effects of simple baseline clinical indicators of risk, this apparent benefit reflected the fact that angiography was performed in those at lowest risk.

Objective: This prospective study sought to determine the rate of thrombolysis in myocardial infarction and the factors that influenced it in everyday practice., Methods and Results: Data were prospectively collected in all patients admitted in all (48) university, community, and private hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Data from 2,515 patients were included. Overall, 36% of the patients received thrombolysis. The decrease of the thrombolysis rate with age was very regular. The difference between men and women disappeared almost completely when age was taken into account in a bivariate analysis. Among 19 variables introduced in the logistic regression, only the following ones were significant predictors (odds ratio < 1 means less thrombolysis): age (odds ratio: 0.60 per decade), administrative department, type of hospital (community/tertiary: 0.74; private/tertiary: 0.58), history of myocardial infarction or of angina pectoris (0.67), location of myocardial infarction (Q wave non anterior/Q wave anterior: 0.75; non Q wave/Q wave anterior: 0.18), delay between symptoms onset and first medical intervention (0.06), history of cancer (0.47), and history of psychiatric disorder (0.38)., Conclusions: In France as in other countries, the rate of thrombolysis is low. In order to increase this rate, we have to find ways to be more "aggressive" in older patients, and to precisely describe the health care pathways in order to shorten delays.

Objective: This study sought to compare characteristics and management of myocardial infarction in men and women, and whether a difference in management would translate into a difference in in-hospital mortality., Methods and Results: Data were prospectively collected in 2,519 patients (801 women) admitted in all hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Women were older than men (76 vs. 64 years). The interval between symptom onset and initial medical intervention was longer in women than in men (median: 180 vs. 135 minutes), as was the interval between symptom onset and hospital admission (median: 315 vs. 255 minutes). After age-adjustment, women were less often smokers, and more often hypertensive or diabetic than men, location of infarction was more often anterior in women, as congestive heart failure at admission. In multivariate analysis, thrombolysis rate was not significantly different in both sexes, whereas noninvasive tests, coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting were significantly less often performed in women than in men. Although in-hospital mortality was higher in women than in men (21% vs. 11%), this difference disappeared after age-adjustment (relative risk = 0.99). In multivariate analysis, gender was not an independent predictor of survival., Conclusions: Although in-hospital mortality after myocardial infarction was similar in both sexes, rates of diagnostic and therapeutic procedures were lower in women than in men. This raises the question of whether mortality would decrease in women if management were similar in both sexes.

Objective: This study sought to examine the use of treatments at discharge in patients hospitalized for myocardial infarction in a French region., Methods and Results: Data from 2,102 patients discharged after myocardial infarction were prospectively collected at 48 university, community, and private hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. Beta-blockers were prescribed in 59% of the patients, calcium channel blockers in 22%, nitrates in 59%, antiplatelet agents in 82%, anticoagulants in 26%, angiotensin-converting enzyme inhibitors in 36%, diuretics in 33%. Beta-blockers were prescribed less often in older patients, and in patients with higher Killip classes or a history of pulmonary disease. Calcium channel blockers were prescribed more often in older patients, and in patients with a history of diabetes, pulmonary disease, or non-Q wave myocardial infarction. Nitrates were prescribed more often in older patients. Angiotensin-converting enzyme inhibitors were prescribed more often in patients with a history of diabetes, hypertension, or anterior myocardial infarction, and less often in patients with a history of renal failure. Diuretics were prescribed more often in older patients, and in patients with a history of renal failure, diabetes, hypertension, or higher Killip classes., Conclusions: There is still underuse of beneficial treatments, particularly in elderly patients.

Objective: The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regardless of age and hospital facilities, in the "real world" in a region in France., Methods and Results: Data were prospectively collected in all patients with MI admitted in all hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. 2,519 patients (68% men; mean +/- SD: 68 +/- 14 years) were included. Time from onset of symptoms to admission was < 6 h in 56% of the patients (median: 4 h 30 min). MI was non-Q wave in 12%. Among Q wave MI, location was anterior in 44%. At admission, Killip class was > 1 in 33%. The overall rate of thrombolysis was 36%. It was significantly higher in men than in women, in younger patients than in older patients, in lower Killip classes, in Q wave MI, and when the delay before initial medical intervention was < 6 hours. After age-adjustment, there was no difference between men and women for thrombolysis rate (odds ratio women/men: 0.92; p = 0.10). During the first 5 days, Killip class worsened in 17%. In-hospital mortality rate was 14%. Multivariate analysis identified age, anterior location, presence of Q waves, and higher Killip classes as significant predictors of in-hospital mortality., Conclusions: This large unselected cohort revealed that among patients with MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.