Discussion
The Seven Countries Study is a significant milestone in epidemiological research on cardiovascular diseases. The study, which included seven countries, was the first to confirm that the incidence of coronary disease was significantly different among countries (19), with the incidence of the disease is exceptionally high in Finland. Further research also revealed a significant difference between the WR and ER of Finland (20). Knowledge of the shocking extent of this difference, as well as local initiative, resulted in the launch of the North Karelia Project, which eventually demonstrated that the incidence of myocardial infarction could be decreased by the population-level control of the risk factors (21). Several publications appeared following these classical studies, whose authors called attention to regional differences regarding the incidence and treatment of myocardial infarction (13, 22-29). Upon examining the same problem, several articles underlined the role of the social environment of the population (30-33).
In a meta-analysis of several studies, Manrique-Garcia et al. (14) found that the incidence of myocardial infarction was influenced both by the social and economic status of the population, as well as their educational background, i.e. the incidence of myocardial infarction was higher in underprivileged people. Israeli authors compared the hospital treatment data of Israeli-born and immigrant patients treated for myocardial infarction, along with their short- and long-term mortality rates. Israeli-born citizens showed a higher ratio of revascularisation for STEMI, whereas their short- and long-term mortality rates were lower. Among the immigrant patients, the highest 10-year mortality rates were detected in those who migrated from Yemen, Southern Europe and the Balkans; the prognoses of Central European and Pakistani immigrants showed no differences (34). For the complex examination of infarction care, continuous registers were created in several European countries (2, 3, 5), enabling quality assurance for care, as well as monitoring of changes in treatment. Based on population data, it has become possible to compare data from different countries (6, 8, 9); nevertheless, when evaluating the data, methodological differences pose a problem (10).
The European Society of Cardiology initiated a European registry programme to uniformly follow major cardiological diseases in 2019, called Unified Registries On Heart Care Evaluation and Randomised Trials (11). In the present study, we compared the data of the three major regions of Hungary with respect to the incidence of myocardial infarction, patients’ clinical data, emergency care and prognosis. Both types of infarction were most common (42.9% and 36.3% of all cardiovascular events), and the incidence of myocardial infarction was highest in the ER. Compared with US data from 2008, the incidence of myocardial infarction for the total population was higher in Hungary: 177.5% vs. 168 per 100,000 person-years (35). Stroke and peripheral artery disease were also the most common diseases in the medical history of patients living in the ER, wherein TIT was longest (262 min). Delays until revascularisation were primarily caused by patient delay as the most unfavourable values in emergency care were found in the CR (in the case of T1 and T2 values). The revascularisation ratio was 84.6% in the STEMI group and 58.8% in the NSTEMI group.