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Összefoglaló. Előzmény: A szívinfarktus miatt kezelt betegek ellátásának regionális adataira és a betegek hosszú távú kórlefolyására vonatkozó hazai kutatás eddig nem történt. Célkitűzés: A vizsgálat célja a Magyar Infarktus Regiszter pilotidőszakában rögzített betegeknél az ellátás és a 10 éves túlélés elemzése a magyarországi nagyrégiókban. Módszer: A Magyar Infarktus Regiszter (későbbi neve: Nemzeti Szívinfarktus Regiszter) 2010. január 1. és 2013. december 31. között a centrumok önkéntes részvételével 23 142 beteg adatait rögzítette, akik írásban hozzájárultak egészségügyi és klinikai adataik kezeléséhez. Az adatgyűjtés a Kutatásetikai Bizottság engedélyével rendelkezett. A vizsgált populációban 12 104, ST-elevációval járó myocardialis infarctuson (STEMI) és 10 768, ST-elevációval nem járó myocardialis infarctuson (NSTEMI) átesett beteg szerepelt. A feldolgozott adatok 128 220 betegévre vonatkoznak, amelyeket nagyrégiók szerint (Nyugat-, Közép- és Kelet-Magyarország) hasonlítottunk össze. Eredmények: A STEMI-betegek 78,4%-ánál, az NSTEMI-betegek 51,6%-ánál történt katéteres érmegnyitás (PCI). NSTEMI esetén a Közép-Magyarország és Nyugat-Magyarország régiókban a beavatkozás gyakoribb volt, mint a Kelet-Magyarország régióban (pKövetkeztetés: A magyarországi nagyrégiók között az infarktusos betegek ellátásában és prognózisában regionális különbségek vannak. Orv Hetil. 2021; 162(36): 1438–1450. Summary. History: Regional data on patients’ care for myocardial infarction and the long-term follow up of patients have not yet been studied in Hungary. Objective: The study aims to analyze the care and 10-year survival of patients recorded during the Hungarian Myocardial Infarction Registry’s pilot period in large regions of Hungary. Method: Between Jan 1, 2010 and Dec 31, 2013, the Hungarian Myocardial Infarction Registry recorded data on 23 142 patients with voluntary participation. The Research Ethics Committee approved the program. The study included 12 104 patients with ST-elevation myocardial infarction (STEMI) and 10 768 patients with non-ST-elevation myocardial infarction (NSTEMI). The data processed refer to 128 220 patient years based on large regions (West, Central and East Hungary). Results: Percutaneous coronary intervention occurred in 78.4% of STEMI patients and 51.6% of NSTEMI patients. In the NSTEMI group, percutaneous coronary interventions (PCIs) in the Central-Hungary and West-Hungary regions were significantly more common than in the East-Hungary region (pConclusion: There are regional differences in the care and prognosis of patients with myocardial infarction. Orv Hetil. 2021; 162(36): 1438–1450.

Background: The authors analyzed data from the Hungarian Myocardial Infarction Registry (HUMIR) to examine the potential impact of gender on the treatment and 30-day and 1-year mortality o...

Összefoglaló. Előzmény: A szívinfarktus miatt kezelt betegek ellátásának regionális adataira és a betegek hosszú távú kórlefolyására vonatkozó hazai kutatás eddig nem történt. Célkitűzés: A vizsgálat célja a Magyar Infarktus Regiszter pilotidőszakában rögzített betegeknél az ellátás és a 10 éves túlélés elemzése a magyarországi nagyrégiókban. Módszer: A Magyar Infarktus Regiszter (későbbi neve: Nemzeti Szívinfarktus Regiszter) 2010. január 1. és 2013. december 31. között a centrumok önkéntes részvételével 23 142 beteg adatait rögzítette, akik írásban hozzájárultak egészségügyi és klinikai adataik kezeléséhez. Az adatgyűjtés a Kutatásetikai Bizottság engedélyével rendelkezett. A vizsgált populációban 12 104, ST-elevációval járó myocardialis infarctuson (STEMI) és 10 768, ST-elevációval nem járó myocardialis infarctuson (NSTEMI) átesett beteg szerepelt. A feldolgozott adatok 128 220 betegévre vonatkoznak, amelyeket nagyrégiók szerint (Nyugat-, Közép- és Kelet-Magyarország) hasonlítottunk össze. Eredmények: A STEMI-betegek 78,4%-ánál, az NSTEMI-betegek 51,6%-ánál történt katéteres érmegnyitás (PCI). NSTEMI esetén a Közép-Magyarország és Nyugat-Magyarország régiókban a beavatkozás gyakoribb volt, mint a Kelet-Magyarország régióban (p0,01). Az utánkövetés során a PCI a Nyugat-Magyarország régióban, a revascularisatiós szívműtét (CABG) a Nyugat-Magyarország és a Kelet-Magyarország régióban szignifikánsan gyakoribb volt, mint a Közép-Magyarország régióban (p0,01). A STEMI-betegek között a 10 év alatt a férfiak 49,2%-a, a nők 46,6%-a halt meg, az NSTEMI-csoportban 63%, illetve 57,6%. Az akut szakban elvégzett PCI mindkét betegcsoportban, nemben, az utánkövetés minden időpontjában és a vizsgált régiókban csökkentette a halálozást (p0,01). A STEMI-betegek esetén a túlélés a régiók között nem különbözött (p = 0,72), míg az NSTEMI után a 10 éves túlélés a Nyugat-Magyarország régióban jobb volt (p0,01). Következtetés: A magyarországi nagyrégiók között az infarktusos betegek ellátásában és prognózisában regionális különbségek vannak. Orv Hetil. 2021; 162(36): 1438-1450.Regional data on patients' care for myocardial infarction and the long-term follow up of patients have not yet been studied in Hungary.The study aims to analyze the care and 10-year survival of patients recorded during the Hungarian Myocardial Infarction Registry's pilot period in large regions of Hungary.Between Jan 1, 2010 and Dec 31, 2013, the Hungarian Myocardial Infarction Registry recorded data on 23 142 patients with voluntary participation. The Research Ethics Committee approved the program. The study included 12 104 patients with ST-elevation myocardial infarction (STEMI) and 10 768 patients with non-ST-elevation myocardial infarction (NSTEMI). The data processed refer to 128 220 patient years based on large regions (West, Central and East Hungary).Percutaneous coronary intervention occurred in 78.4% of STEMI patients and 51.6% of NSTEMI patients. In the NSTEMI group, percutaneous coronary interventions (PCIs) in the Central-Hungary and West-Hungary regions were significantly more common than in the East-Hungary region (p0.01). During follow-up, PCI in the West-Hungary region, revascularization surgery in the West-Hungary and East-Hungary regions were significantly more common than in the Central-Hungary region (p0.01). Among STEMI patients, 49.2% of men and 46.6% of women died within 10 years, while in the NSTEMI group 63% and 57.6%, respectively. PCI reduced mortality in both patient groups, sex, at all times of follow-up and in the regions studied (p0.01). As for STEMI patients, survival was similar in all regions (p = 0.72), while after NSTEMI, 10-year survival in the West-Hungary region was better (p0.01).There are regional differences in the care and prognosis of patients with myocardial infarction. Orv Hetil. 2021; 162(36): 1438-1450.

Abstract: Introduction: The significance of the total ischemic time (from the beginning of the complaint to the opening of the vessel) is an important factor for myocardial salvage. Aim: The aim of the study was to determine the prognostic significance of the TIT in patients with ST elevation myocardial infarction in Hungary. Method: From 1 January 2014 all patients with myocardial infarction were recorded by law in an on-line database of the Hungarian Myocardial Infarction Registry. Between 1 January 2014 and 31 March 2016, 27 157 patients with 28 408 myocardial infarction events were recorded. To investigate TIT, 7146 STEMI patients were selected who were treated with percutaneous coronary intervention (PCI) within 24 hours of the beginning of the complaint and all of its components were known. Results: Average follow-up was 740 ± 346 days. The median time of the TIT is 260 minutes, within which the earliest prehospital time was found (median 205 minutes). The TIT influenced survival: if this time was less than 400 minutes, the 30-day and the 1-year deaths were 7.5% and 12.2%, respectively. In longer TIT, higher mortality rate was found (9.2% versus 19.7%, respectively). Multivariate analysis was performed for short (

Abstract: Introduction and aim: By using the database of the National Registry of Myocardial Infarction, the authors examine the prognosis of patients treated with acute myocardial infarction, in case of whom there was new or presumably new left bundle branch block (nLBBB) on the ECG recorded at hospitalization. Method: We recorded the details of 18 091 patients treated with acute myocardial infarction (AMI) between 1 January 2014 and 30 June 2015 in the National Registry of Myocardial Infarction. In case of 8334 patients, the clinical diagnosis was ST-elevation myocardial infarction (STEMI), whereas in 9757 cases it was non-ST elevation myocardial infarction (NSTEMI). In the STEMI population we examined the clinical characteristics and prognosis of patients with ST-elevation (n = 7937) and nLBBB (n = 397). We used the proportional hazards regression model (Cox-regression) to examine mortality. Results: In the AMI patient population, we found LBBB in 1274 cases (7%). In case of STEMI clinical diagnosis, the patients belonging to the nLBBB subpopulation (n = 397) were older, and the proportion of men and the occurrence of co-morbidities was higher than in case of those who had ST-elevation on their ECG recorded at hospitalization. The mortality rate of the LBBB population was higher than that of the ST-elevation patient population in both the 30-day (25.4% versus 12.4%) and the 1-year period (47.3 versus 19.9%). Percutaneous coronary intervention (PCI) had significantly lower mortality in both populations. In the course of a multifactorial analysis we verified the independent prognostic significance of LBBB: the hazard ratio compared to ST-elevation was 1.33 (95% confidence interval: 1.10–1.62), checked for gender, age, occurrence of PCI, systolic blood pressure, cardiac frequency, serum creatinine difference, and the details of five anamneses/co-morbidities. Conclusion: The admission ECG has prognostic significance. Patients with LBBB have poorer prognosis compared to patients with ST-elevation on admission ECG. Orv Hetil. 2018; 159(17): 677–681.

Abstract: Introduction and aim: The aim was to study the patients’ adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome. Method: Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model adherence and survival time. Results: Good adherence (\>80%) to clopidogrel, statins, beta blockers, aspirin and ARB/ACEI was found in 64.9%, 54.4%, 36.5%, 31.7% and 64.0%, respectively. Patients treated with PCI during the index hospitalization had higher adherence to all medication (all p

Abstract: The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure. Conclusion: comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90–93.

Introduction: To the best of the authors’ knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention. Aim: The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention. Method: The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of time-to-death, controlling for age, sex, and comorbidities. Results: The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p

The authors review data sources related to death arising from myocardial infarction, as well as the major elements of the Hungarian data collection of the Central Statistical Office, the National Health Insurance Fund and the National Registry of Myocardial Infarction. They also discuss conclusions which can be drawn from the data. It was found that the financial database – in accordance with its purpose – is suitable for monitoring the costs arising during the treatment of patient, but the quality and efficiency of treatment cannot be judged on the basis of this database. The Central Statistical Office compiles mortality data on the basis of international conventions, the basis of which is the autopsy report. However, the validity of statistical data depends on the correct completion of this report. Therefore. it is not possible to judge treatment of patients with myocardial infarction simply on the basis of mortality statistics. Considering national databases, only patient registries are suitable for monitoring the quality and efficiency of treatment currently. It is recommended that data of the National Registry of Myocardial Infarction should be used when the quality of treatment of patients with myocardial infarction is evaluated. Orv. Hetil., 2016, 157(3), 89–93.

The significance of the total ischemic time (from the beginning of the complaint to the opening of the vessel) is an important factor for myocardial salvage.The aim of the study was to determine the prognostic significance of the TIT in patients with ST elevation myocardial infarction in Hungary.From 1 January 2014 all patients with myocardial infarction were recorded by law in an on-line database of the Hungarian Myocardial Infarction Registry. Between 1 January 2014 and 31 March 2016, 27 157 patients with 28 408 myocardial infarction events were recorded. To investigate TIT, 7146 STEMI patients were selected who were treated with percutaneous coronary intervention (PCI) within 24 hours of the beginning of the complaint and all of its components were known.Average follow-up was 740 ± 346 days. The median time of the TIT is 260 minutes, within which the earliest prehospital time was found (median 205 minutes). The TIT influenced survival: if this time was less than 400 minutes, the 30-day and the 1-year deaths were 7.5% and 12.2%, respectively. In longer TIT, higher mortality rate was found (9.2% versus 19.7%, respectively). Multivariate analysis was performed for short (30 days), medium (30-364 days) and long-term (≥365 days) survival. Diabetes mellitus is a short-term prognostic factor, abnormal creatinine, and severe coronary status have affected short and medium survival. PCI was significant in terms of medium and long-term survival. Previous myocardial infarction and TIT influenced the long-term survival significantly.In Hungary, TIT is too long, and its dominant part falls within the prehospital period. The TIT is an independent prognostic factor, so reducing this time can improve the long-term prognosis of patients with ST-elevation myocardial infarction. Orv Hetil. 2018; 159(27): 1113-1120.Absztrakt: Bevezetés: Az ST-elevációval járó szívinfarktusban (STEMI) a panasz kezdetétől az ér megnyitásáig eltelt idő (teljes ischaemiás idő = TIT) jelentősége a szívizommentés tekintetében jól ismert. Célkitűzés: A magyarországi, ST-elevációval járó szívinfarktusos betegeknél a TIT meghatározása és prognosztikus jelentőségének vizsgálata Magyarországon. Módszer: A szívinfarktusos betegek klinikai paramétereit, ellátásuk adatait az ellátók 2014. január 1-je óta kötelező jelleggel rögzítik a Nemzeti Szívinfarktus Regiszter rendszerében. 2014. január 1. és 2016. március 31. között 27 157 beteg 28 408 infarktusos eseményének adata került rögzítésre. Vizsgálatunkban 7146, STEMI miatt kezelt beteg szerepelt, akiknél a panasz kezdetétől számított 24 órán belül percutan coronariaintervenció (PCI) történt, és ismertek voltak a részidők. Eredmények: Az utánkövetés átlaga 740 ± 346 nap volt. A TIT mediánja 260 perc, ezen belül a leghosszabbnak a prehospitális időt találtuk (medián 205 perc). A TIT befolyásolta a túlélést: amennyiben ez az idő 400 percnél rövidebb volt, akkor a 30 napos, illetve az 1 éves halálozás 7,5%, illetve 12,2% volt. Az ennél hosszabb idő esetén 9,2%, illetve 19,7% halálozási értékeket találtunk. A többváltozós elemzéskor rövid (30 nap), közép- (30–364 nap) és hosszú távú (≥365 nap) túlélést vizsgáltunk. A diabetes a rövid, míg a kóros kreatininérték, a súlyos koszorúérstatus a rövid és a középtávú túlélést befolyásolta. A PCI a közép- és a hosszú távú túlélés szempontjából volt jelentős. A megelőző myocardialis infarctus és a TIT a hosszú távú túlélést befolyásolta szignifikáns mértékben. Következtetések: A TIT Magyarországon hosszú, az időveszteség döntő része a prehospitális időszakra esik. A TIT önálló prognosztikai tényező, az időveszteség csökkentése javíthatja a betegek késői életkilátásait. Orv Hetil. 2018; 159(27): 1113–1120.

By using the database of the National Registry of Myocardial Infarction, the authors examine the prognosis of patients treated with acute myocardial infarction, in case of whom there was new or presumably new left bundle branch block (nLBBB) on the ECG recorded at hospitalization.We recorded the details of 18 091 patients treated with acute myocardial infarction (AMI) between 1 January 2014 and 30 June 2015 in the National Registry of Myocardial Infarction. In case of 8334 patients, the clinical diagnosis was ST-elevation myocardial infarction (STEMI), whereas in 9757 cases it was non-ST elevation myocardial infarction (NSTEMI). In the STEMI population we examined the clinical characteristics and prognosis of patients with ST-elevation (n = 7937) and nLBBB (n = 397). We used the proportional hazards regression model (Cox-regression) to examine mortality.In the AMI patient population, we found LBBB in 1274 cases (7%). In case of STEMI clinical diagnosis, the patients belonging to the nLBBB subpopulation (n = 397) were older, and the proportion of men and the occurrence of co-morbidities was higher than in case of those who had ST-elevation on their ECG recorded at hospitalization. The mortality rate of the LBBB population was higher than that of the ST-elevation patient population in both the 30-day (25.4% versus 12.4%) and the 1-year period (47.3 versus 19.9%). Percutaneous coronary intervention (PCI) had significantly lower mortality in both populations. In the course of a multifactorial analysis we verified the independent prognostic significance of LBBB: the hazard ratio compared to ST-elevation was 1.33 (95% confidence interval: 1.10-1.62), checked for gender, age, occurrence of PCI, systolic blood pressure, cardiac frequency, serum creatinine difference, and the details of five anamneses/co-morbidities.The admission ECG has prognostic significance. Patients with LBBB have poorer prognosis compared to patients with ST-elevation on admission ECG. Orv Hetil. 2018; 159(17): 677-681.

Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96% vs PFT guided: 85%, p

The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure.comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90-93.

The authors delineate the circumstances of the creation of the National Myocardial Infarction Registry program. This web-based program started in January 1, 2010 as a “pilot” study with the voluntary participation of 12 centres. As a result of professional consensus, the number of participating institutions has continuously increased and, since March 1, 2013, data supply has become obligatory for hospitals treating patients with myocardial infarction. In December, 2013 a new modification of certain health and health insurance related acts such as Act XLVII/1997 regulated the operation of National Myocardial Infraction Registry. At present 65 institutions provide data regularly. The number of patients with myocardial infarction in the database was 24308 in January 1, 2014. The authors summarize the data which accumulated during almost four years of functioning of the National Myocardial Infarction Registry Program. The incidence of myocardial infarction was defined by reviewing the number of pre hospital and hospital cases in five districts of the capital and Szabolcs-Szatmár-Bereg County of Hungary. Reviewing the records patients with ST-elevation and non-ST-elevation myocardial infarction revealed that treatment of 91% of ST-elevation patients occurred in hospitals with cardiac catheterization laboratory, and 82% of patients had primary percutaneous coronary intervention. In-hospital, 30-day and 1-year mortality were defined for patients treated for both types of myocardial infarction. Based on national and international experience, the authors emphasize that professional characteristics of patient care can only be assessed using specific patient registries and these data are essential in the development of an efficient health-care system. Orv. Hetil., 2014, 155(19), 740–744.

Introduction: Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary. Aim: To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database. Method: Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis. Results: Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction. Conclusions: The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups. Orv. Hetil., 2014, 155(21), 828–832.

The authors analyse clinical data, hospital care, and short- and long-term prognosis of 4981 ST segment elevation myocardial infarction (STEMI) patients enrolled in the web-based Hungarian Myocardial Infarction Registry. It has been found that the mean age of STEMI patients was lower by 5.3 years than that of patients treated for non-STEMI (NSTEMI). In the group of NSTEMI patients ( n = 3601), the occurrence of diabetes, hypertension, peripheral vascular disease, and previous history of myocardial infarction and stroke were significantly more frequent. The proportion of smokers among STEMI patients was remarkably higher. Primary percutaneous coronary intervention (PPCI) was performed in 91.1% of STEMI patients. In the case of PPCI-treated patients, the median of ‘door-to-needle time’ was 45 min; the median of time from the onset of complaints to reperfusion was 210 min. The in-hospital mortality rate of STEMI patients was 3.7%, and 30-day and 1-year mortality rates were 9.5 and 16.5%, respectively. In the logistic regression analysis age, diabetes mellitus, a history of prior myocardial infarction and stroke, Killip class at admission, and PPCI proved to have prognostic significance. PPCI decreased the odds ratio for 30-day mortality by 71%, for 1-year mortality by 51%. The authors find the prospective clinical data collection (Infarction Registry) a valuable tool of quality control.

To the best of the authors' knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention.The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention.The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of time-to-death, controlling for age, sex, and comorbidities.The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p0.0001) factor of survival, with right coronary artery exhibiting a highly significantly better prognosis (hazard ratio 0.69, 95% CI 0.61-0.79, p0.0001) and left main artery exhibiting a significantly worse prognosis (hazard ratio 1.56, 95% CI 1.04-2.35, p = 0.0321) than the reference vessel (left anterior descendent artery).These data demonstrate that the culprit vessel has independent prognostic significance. Orv. Hetil., 2016, 157(32), 1282-1288.

Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI).Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching.A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1±12.4years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p0.001, both). This benefit remained consistent in age-dependent subgroup analyses.Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.

Authors present the methodology and first data of Hungarian Myocardial Infarction Register Pilot Study started 1st of January, 2010. The aim of the study is to collect epidemiological data on myocardial infarction, to examine the natural history of the disease and to investigate the main characteristics on patient care in the pilot area. The program is using standardized diagnostic criteria and predefined electronic data record forms (eCRF). The pilot area consists of 5 districts in the capital, and Szabolcs-Szatmár-Bereg county. The area has 997 324 inhabitants. Eight cardiology departments, 5 with heart catheterization facility (C) in Budapest, four hospitals with one C in Szabolcs-Szatmar-Bereg county have been responsible of the patients’ care. After starting the program 16 other hospitals joined the program from different parts of Hungary. Between 1st of January 2010 and 1st of May 2011 4293 patients were registered, among them 52.1% with ST segment elevation myocardial infarction (STEMI), 42.1% with non-ST segment elevation myocardial infarction (NSTEMI), while 3% of the patients had unstable angina, and 2.8% of the cases had other diagnosis or the hospital diagnosis was missing in the eCRF. Authors compare the patients care with STEMI in five districts of Budapest and Szabolcs-Szatmár-Bereg county. In Budapest 79.7% of the 301 STEMI patients were treated in C and 84.6% of them were treated with primary percutaneous intervention (pPCI). In Szabolcs-Szatmár-Bereg county 402 patients were registered with STEMI, 62.9% of them were treated in C, where 77% of them were treated with pPCI. The drugs (beta blockers, ACE inhibitors, statins) important for secondary prevention were given more often to patients treated in the capital, however no difference was found in the platelet aggregation inhibitors therapy. Hospital mortality of STEMI patients was 8% in the capital, and 10% in Szabolcs- Szatmár-Bereg county. Authors conclude that the web based myocardial infarction register is feasible and important to have reliable data on patient care and a necessary quality control tool. Authors propose to broaden this pilot program and to start a nationwide myocardial infarction register. Orv. Hetil., 2011, 152, 1278–1283.

Aims: Authors summarize the most important findings of the Myocardial Infarction Community Registry conducted in Hungary 40 years ago. The report is important because data are not available on the internet through literature search and since 40 years such study has not been performed. The incidence of acute myocardial infarction in subjects older than 20 years of age in the population of South Pest with 400 000 inhabitants in 1971 was 50.9/10 000 in men and 23.7/10 000 in women. The mortality rate of myocardial infarction during the first year was 56.2% in men and 60.7% in women. Two-third of the first-year death occurred in the first 24 hours and 85% of it in the prehospital period. Only 6% of the patients with acute myocardial infarction were admitted and treated in Coronary Care Units. Based on the data of the Myocardial Infarction Community Registry, measures were introduced which decreased the 28-days mortality rate at the population level. Conclusions: Authors emphasize that in the last decades the diagnosis and treatment of myocardial infarction has substantially changed which makes it necessary to re-evaluate by epidemiologic methods the natural history, incidence and mortality of acute myocardial infarction in Hungary. Orv. Hetil., 2011, 152, 793–796.

Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary.To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database.Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis.Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction.The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups.Bevezetés: A szívinfarktus különböző megjelenési formái miatt kezelt betegek klinikai jellemzőivel kapcsolatban kevés hazai adattal rendelkezünk. Célkitűzés: A szerzők a Nemzeti Szívinfarktus Regiszter adatbázisában szereplő ST-elevációs és nem ST-elevációs szívinfarktus miatt kezelt betegek fontosabb klinikai paramétereinek és ellátásának elemzését tűzték ki célul. Módszer: A Nemzeti Szívinfarktus Regiszterben 2010. január 1. és 2012. június 30. között rögzített 6670 ST-elevációs és 5237 nem ST-elevációs szívinfarktussal kezelt beteg adatait elemezték. Eredmények: A nem ST-elevációs szívinfarktus miatt kezelt betegek idősebbek voltak és több társbetegséggel rendelkeztek, mint az ST-elevációs infarktusos betegek. Koronarográfiára és katéteres érmegnyitásra gyakrabban került sor ST-elevációs infarktus esetén. A kórházi halálozásban nem volt különbség a két csoport között (5,3% vs. 4,9%). A szekunder prevenciós gyógyszeres kezelést közel 90%-ban kapták meg a betegek mindkét csoportban, a kettős thrombocytaaggregáció-gátló kezelés gyakoribb volt ST-elevációs infarktus esetén. Következtetések: A két betegcsoport fontos klinikai jellemzők tekintetében különbözik egymástól, ugyanakkor a betegek kórházi prognózisa hasonló. Orv. Hetil., 2014, 155(21), 828–832.

The authors delineate the circumstances of the creation of the National Myocardial Infarction Registry program. This web-based program started in January 1, 2010 as a "pilot" study with the voluntary participation of 12 centres. As a result of professional consensus, the number of participating institutions has continuously increased and, since March 1, 2013, data supply has become obligatory for hospitals treating patients with myocardial infarction. In December, 2013 a new modification of certain health and health insurance related acts such as Act XLVII/1997 regulated the operation of National Myocardial Infraction Registry. At present 65 institutions provide data regularly. The number of patients with myocardial infarction in the database was 24308 in January 1, 2014. The authors summarize the data which accumulated during almost four years of functioning of the National Myocardial Infarction Registry Program. The incidence of myocardial infarction was defined by reviewing the number of pre hospital and hospital cases in five districts of the capital and Szabolcs-Szatmár-Bereg County of Hungary. Reviewing the records patients with ST-elevation and non-ST-elevation myocardial infarction revealed that treatment of 91% of ST-elevation patients occurred in hospitals with cardiac catheterization laboratory, and 82% of patients had primary percutaneous coronary intervention. In-hospital, 30-day and 1-year mortality were defined for patients treated for both types of myocardial infarction. Based on national and international experience, the authors emphasize that professional characteristics of patient care can only be assessed using specific patient registries and these data are essential in the development of an efficient health-care system.A szerzők ismertetik a Nemzeti Szívinfarktus Regiszter program létrehozásának körülményeit. A webalapú vizsgálat 2010. január 1-jén „pilot” tanulmányként indult 12 centrum önkéntes részvételével. A szakmai konszenzus eredményeként folyamatosan nőtt a programban részt vevő intézetek száma, majd 2013. március 1-jétől az infarktusellátásban részt vevő intézmények számára az adatszolgáltatás kötelező feladattá vált. A Magyar Országgyűlés 2013 decemberében az Eüak törvény 10. § 2. bekezdésének módosításával törvényben szabályozta a Nemzeti Szívinfarktus Regiszter működését. 2014. január 1-jén 65 ellátóhely szolgáltatott rendszeresen adatokat, az adatbázisban szereplő infarktusos betegek száma 24 308 volt. A szerzők összefoglalják a Nemzeti Szívinfarktus Regiszter közel négyéves működése során ismertté vált adatokat. A főváros öt kerületében és Szabolcs-Szatmár-Bereg megyében a prehospitális és a kórházi esetek számbavételével meghatározták a myocardialis infarctus incidenciáját. Az ST-elevációval járó és a nem ST-elevációval járó infarktusos betegek ellátását vizsgálva megállapítják, hogy az ST-elevációval járó infarktusos betegek 91%-ának kezelése szívkatéteres lehetőséggel rendelkező intézetben történt, és a betegek 82%-ánál primer percutan coronariaintervenció történt. Meghatározták a kétfajta infarktus miatt kezelt betegek kórházi, 30 napos és 1 éves halálozását. Hazai és nemzetközi tapasztalatok alapján a szerzők hangsúlyozzák, hogy a betegellátás szakmai jellemzői csak speciális betegregiszterek működtetésével elemezhetők, és ezen adatok nem nélkülözhetők egy hatékony egészségügyi ellátórendszer kialakításához. Orv. Hetil., 2014, 155(19), 740–744.

Mortality data of patients with acute myocardial infarction are incomplete in Hungary.The aim of the authors was to analyse the data of 8582 myocardial infarction patients (4981 with ST-elevation myocardial infarction) registered in the Hungarian Myocardial Infarction Register in order to define the hospital, 30-day, and 1-year mortality. To evaluate the prehospital mortality of myocardial infarction, all myocardial infarction and sudden death were registered in five districts of Budapest.Multivariate logistic regression was performed to define risk factors of mortality and the model were assessed using c statistics.The hospital, 30-day and 1-year mortality of patients with ST elevation myocardial infarction were 3.7%, 9.5% and 16.5%, respectively. In patients without ST elevation myocardial infarction these figures were 4%, 9.8% and 21.7%, respectively. The 1-year mortality of patients without ST elevation was higher than those of with ST elevation and the difference was statistically significant. Age, Killip class, diabetes mellitus, history of stroke and myocardial infarction were independent predictors of death. Coronary intervention improved the prognosis of patients with myocardial infarction significantly.The rate of pre-hospital mortality was considerably high; 72.5% of 30 day mortality occurred before admission to hospital.Bevezetés: A heveny szívizominfraktust elszenvedett betegek halálozására vonatkozó hazai adatok hiányosak. Célkitűzés: A szerzők a Magyar Infarctus Regiszterben szereplő 8582 infarktusos beteg (4981 ST-elevációval járó myocardialis infarctus) adatainak elemzésével a kórházi, a 30 napos és az egyéves halálozás vizsgálatát tűzték ki célul. Budapest öt kerületében rögzítették a prehospitális haláleseteket. Módszer: A halálozás kockázati tényezőinek vizsgálatára logisztikus regressziós analízist végeztek, majd ellenőrizték a modell illeszkedését. Eredmények: A kórházi, a 30 napos, illetve az egyéves halálozás az ST-elevációval járó infarktusos betegcsoportban 3,7%, 9,5%, illetve 16,5%, a nem ST-elevációs betegcsoportban 4%, 9,8% és 21,7% volt. A nem ST-elevációval járó infarktus miatt kezelt betegek egyéves halálozása szignifikánsan magasabb volt. A halálozás kockázati tényezőit vizsgálva az életkor, a Killip-stádium, a kórelőzményben szereplő myocardialis infarctus, stroke, valamint a diabetes bizonyult prognosztikus jelentőségűnek. A percutan coronariaintervenció mindkét típusú infarktusban nagyon jelentősen javította a betegek rövid és hosszú távú életkilátásait. Következtetések: A prehospitális halálozás igen jelentős volt, a 30 napon belül bekövetkező események 72,5%-a kórházon kívül történt. Orv. Hetil., 2013, 154, 1297–1302.

In the last few decades data on the incidence of acute myocardial infarction are not available in Hungary.The aim of the authors was to define the incidence of myocardial infarction using the Hungarian Infarction Registry according to the number of in- and out-of-hospital cases in five districts of the capital (districts II, III, IX, X and XVII) and Szabolcs-Szatmár-Bereg county.Besides using the Hungarian Infarction Registry, databases of the National Public Health and Medical Officer Service and that of the Hungarian Central Statistical Office were used in order to define the incidence of prehospital cases, according to the regulations presented in an earlier proposal of the Data Protection Ombudsman of Hungary.For 10 000 residents the incidence of myocardial infarction in the capital was 28.63 in males and 16.21 in females, while in Szabolcs-Szatmár-Bereg county the mean incidence was 32.49 for males and 18.59 for females. The mean incidence of myocardial infarction in the five districts of the capital in males and females did not differ from the mean values of Szabolcs-Szatmár-Bereg county. When comparing the incidence values in different districts of the capital to the countryside, the Szabolcs-Szatmár-Bereg county had significantly higher values for both males and females compared to districts II and III of the capital, while in district X the incidence of myocardial infarction in males was significantly lower compared to the values in the countryside.Using the mean incidence results projected to the capital and countryside population according to age and gender, 20 000 new myocardial infarction cases might be expected per year in Hungary.Bevezetés: A heveny szívinfarktus gyakoriságára vonatkozó hazai adatokkal évtizedek óta nem rendelkezünk. Célkitűzés: A szerzők célul tűzték ki a Magyar Infarctus Regiszter Program működése során a főváros öt kerületében (II., III., IX., X. és XVII. kerület) és Szabolcs-Szatmár-Bereg megyében a kórházi és a kórházon kívüli esetek számbavételével a myocardialis infarctus incidenciájának vizsgálatát. Módszer: A regiszter adatbázisán kívül – a prehospitális esetek gyakoriságának megállapításához – az Állami Népegészségügyi Intézet, valamint a Központi Statisztikai Hivatal adatbázisát használták fel az adatvédelmi ombudsman korábbi állásfoglalásában leírt szabályok betartásával. Eredmények: A fővárosban a szívizominfarktus 10 000 lakosra számított incidenciája férfiak esetén 28,63 és nőknél 16,21 volt, míg Szabolcs-Szatmár-Bereg megyében a férfiak átlagos incidenciája 32,49, a nőké 18,59 volt. A főváros öt kerületében a myocardialis infarctus incidenciájának átlaga sem a férfiak, sem a nők körében nem különbözött a Szabolcs-Szatmár-Bereg megyei értékek átlagától. Az egyes fővárosi kerületek incidenciaértékeit hasonlítva a vidéki adatokhoz, azt találták, hogy a Szabolcs-Szatmár-Bereg megyei értékek mind a férfiak, mind a nők esetén szignifikánsan magasabbak voltak, mint amit a főváros II., III. kerületeiben találtak, míg a X. kerületben csak a férfiak incidenciaértéke volt szignifikánsan kisebb, mint a megyei érték. Következtetések: A megfigyelt átlagos incidenciaértékeket kivetítve a főváros, illetve a vidéki lakosság kor és nem szerinti összetételére, Magyarországon évente 20 000 új infarktusos betegre számíthatunk. Orv. Hetil., 2013, 154, 1106–1110.

Introduction: There are only very few data on gender differences in patients with ST-elevation myocardial infarction. Aim: To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Patients and methods: Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Results: Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p

Authors present the methodology and first data of Hungarian Myocardial Infarction Register Pilot Study started 1st of January, 2010. The aim of the study is to collect epidemiological data on myocardial infarction, to examine the natural history of the disease and to investigate the main characteristics on patient care in the pilot area. The program is using standardized diagnostic criteria and predefined electronic data record forms (eCRF). The pilot area consists of 5 districts in the capital, and Szabolcs-Szatmár-Bereg county. The area has 997 324 inhabitants. Eight cardiology departments, 5 with heart catheterization facility (C) in Budapest, four hospitals with one C in Szabolcs-Szatmar-Bereg county have been responsible of the patients' care. After starting the program 16 other hospitals joined the program from different parts of Hungary. Between 1st of January 2010 and 1st of May 2011 4293 patients were registered, among them 52.1% with ST segment elevation myocardial infarction (STEMI), 42.1% with non-ST segment elevation myocardial infarction (NSTEMI), while 3% of the patients had unstable angina, and 2.8% of the cases had other diagnosis or the hospital diagnosis was missing in the eCRF. Authors compare the patients care with STEMI in five districts of Budapest and Szabolcs-Szatmár-Bereg county. In Budapest 79.7% of the 301 STEMI patients were treated in C and 84.6% of them were treated with primary percutaneous intervention (pPCI). In Szabolcs-Szatmár-Bereg county 402 patients were registered with STEMI, 62.9% of them were treated in C, where 77% of them were treated with pPCI. The drugs (beta blockers, ACE inhibitors, statins) important for secondary prevention were given more often to patients treated in the capital, however no difference was found in the platelet aggregation inhibitors therapy. Hospital mortality of STEMI patients was 8% in the capital, and 10% in Szabolcs- Szatmár-Bereg county. Authors conclude that the web based myocardial infarction register is feasible and important to have reliable data on patient care and a necessary quality control tool. Authors propose to broaden this pilot program and to start a nationwide myocardial infarction register.

Background and objective: Cardiovascular disease is a leading cause of death in Eastern Europe. Few studies on cholesterol goal achievement have been conducted in Hungarian clinical settings. This study set out to evaluate lipid-modifying therapy practices and their effects on total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) goal attainment in Hungarian patients with coronary heart disease (CHD), CHD risk equivalents, or ≥2 coronary risk factors. Methods: This multicentre observational study involved patients receiving lipid-modifying therapy who were under the care of general practitioners (n = 300) or specialists (n = 140). Physician questionnaires were used to collect data on baseline patient characteristics, including laboratory parameters. Using validated cardiovascular risk assessment measures, patients were stratified into high-risk (10-year absolute coronary risk >20%; n = 367) and lower risk groups (n = 73). Cholesterol goals were TC 50% of patients needed >35% TC lowering to reach goal

The so-called Program for preventive collaboration model joins the expertise of specialists and GPs and as such allocates for the effective, cost saving, secure screening of individuals with high and intermediate cardiovascular risk and identifying asymptomatic patients within a big population. Based on SCORE risk assessment GPs define their patients cardiovascular risk. In Gottsegen György Institute of Hungarian Cardiology on patients with intermediate or high risk ankle-brachial doppler index, carotis intima media thickness, artery stiffness, microalbuminuria and left ventricular hypertrophy are diagnosed. Based on the results of non-invasive cardiovascular marker tests a mixed score is elaborated. The applicability of the score is then measured for the further risk assessment of individuals with intermediate or high CV risk. The collaboration of GPs and specialists along with the non-invasive cardiological tests are helpful in the early identification of patients with high cardiovascular risk and when making a decision about drug or non-drug treatments.

During the last two decades revolutionary diagnostic and therapeutic changes were implemented in the management of patients with arrhythmias. Since the arrhythmia substrate is frequently associated with certain anatomical structures or morphological variants, improved imaging has increasing role in the improvement of these treatments. Furthermore, novel catheter ablation approaches require catheter placement to sites, which may be associated with increased complication risk. Therefore imaging has a crucial role both in guiding and improving safety of electrophysiology procedures. Recently, intracardiac echocardiography became available providing excellent accuracy in direct visualization of anatomical landmarks. Intracardiac echocardiography is therefore a potentially useful tool for guiding electrophysiology procedures. The first two Hungarian cases with intracardiac echocardiography are presented with a broad background in this comprehensive review.

Recent European and Hungarian guidelines of cardiovascular prevention have clearly defined the target levels in lipid lowering therapy.To analyze the risk status of patients receiving long term lipid lowering therapy and the rate of achievement of target level in a Hungarian multicenter trial.The investigation was performed in January and February of 2004 involving general practitioners and specialists (cardiologists, lipidologists). Applying a questionnaire the authors asked for risk factors and the further implementations in the knowledge of results of each doctors' 10 consecutive patients receiving lipid lowering therapy for at least one year.LDL target levels accepted by the Hungarian Therapic Consensus Conference was achieved in 22% of GP's patients and 27% of specialists' patients, in 24% of patients, in average. According to risk stratification, the 83% of patients receiving lipid lowering therapy were at high risk, and 79% of these did not reach the suggested target level of serum total cholesterol. In 54% of patients not achieving target level the doctors continue the therapy without any modification. Considering therapy modification in the rest of patients, a dose increase was intended in 61%, change of drug in 31% of cases, and rarely the combination therapy.While only a quarter of patients receiving lipid lowering treatment achieved the target levels, along with wide spreading of this kind of therapy further efforts should be made in order to achieve the levels defined in guidelines with dose increase or combination of appropriate drugs.