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.