European Myocardial Infarction Registers

Background/Questions

During the 1950s and early 1960s, ambulatory treatment of angina pectoris, a chronic symptom of coronary heart disease, consisted of pain relief using a limited range of drugs. For myocardial infarction (coronary thrombosis), an acute medical emergency, treatment was morphine, anticoagulants and extended bed-rest. Management was then revolutionized by improved emergency response and resuscitation and electronic monitoring of patients in special coronary care units (1), with attempted reversal of cardiac arrest by electric defibrillation and assisted respiration. New drugs were being introduced. Claims that cardiac mortality was being halved in such units fitted strangely with rising population mortality rates.

This led to an initiative from the European Regional Office of the World Health Organization in the late 1960s to establish Myocardial Infarction Community Registers (2) in which the incidence and outcome of acute coronary events would be studied systematically on a population basis. Both hospitalized myocardial infarction, and out of hospital coronary deaths would be studied together to assess the known and potential impact of coronary care.

Results/Conclusions/Follow-Up

The WHO-affiliated registers established standardized techniques for heart attack registration (Cardiovascular Survey Methods 3) followed by later surveillance researches and by the ambitious international monitoring program of MONICA. (4) They provided a sound base for emergency coronary care and confirmed that the great majority of coronary deaths were occurring in the community, outside hospital, and thus were largely inaccessible to hospital-based acute coronary care and therefore dependent on prevention for reduction of risk and death rates. (HB)