The management of acute myocardial infarction (AMI) has improved markedly over the last decade. Large-scale trials have produced a large amount of evidence, and recommendations and guidelines have been established. Whether and to what extent these data have influenced everyday practice on a nationwide scale remains to be ascertained. The present observational prospective, registry was designed to assess current practice in in-hospital management of AMI in Portugal. For a period of 3 months (February to May, 1999), 44 centers, distributed all over the country, Atlantic islands included, enrolled 1372 cases of AMI corresponding to 1366 patients (996 male, mean age 65 +/- 13 years; 370 female, mean age 72 + 11 years; p < 0.0001). Non-ST segment elevation infarcts were present in 26% of cases. In-hospital mortality was 11.2% (154 pts, mean age 74 +/- 10 years).
Results: 519 pts (37.8%) were managed with reperfusion therapy, 413 of them with fibrinolysis (30.1%) and 106 with primary PTCA (7.7%). Besides the invasive procedures performed within the first few hours after admission, coronary angiography was performed in 327 more pts (26.1%); 143 pts were revascularized (PTCA in 117 pts and CABG in 26) and 96 more pts were discharged and referred for further revascularization. The total number of pts given or referred for a revascularization procedure (including the primary treatment) was 316 (20.6%). Besides reperfusion therapy the most commonly used drugs for secondary prevention were aspirin in 91%; ACE inhibitors in 63%; beta-blockers in 45%; and statins in 28%. Based on the results of this nationwide survey it can be concluded that the main international guidelines and recommendations for the medical management of acute myocardial infarction are generally being applied in Portugal.