Characteristics, management, and in-hospital mortality of acute myocardial infarction in teh 'real world' in France

Objective - The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute Ml) 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 Ml admitted in all hospitals in three departments in the Rhone-Alpes region between September I, 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 I 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 Ml in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.