Purpose: To assess geographical differences within Switzerland
regarding management and revascularization procedures for acute
myocardial infarction (AMI).
Methods: Swiss hospital discharge database for period 2007-2008.
The main inclusion criterion was AMI as a primary discharge diagnosis.
AMI revascularization procedures were identified and seven Swiss
regions (Leman, Mittelland, Northwest, Zurich, Central, Eastern and
Ticino) were analyzed.
Results: Data from 25,674 AMI discharges were analyzed. Almost half
(53.6%) of them were managed in a single hospital, the values ranging
from 63.1% (Leman) to 31.4% (Ticino) see table. Relative to the total
number of discharges, the highest Intensive Care Unit admission rate
was in Leman (69.7%), the lowest (16.4%) in Ticino (Swiss average:
35.8%). Intracoronary revascularization rates were highest in Leman
(51.6%) and lowest (30.8%) in Central Switzerland (Swiss average:
41.4%). Bare (non-drug-eluting) stents use was highest in Leman
(33.1%) and lowest (7.0%) in Ticino (Swiss average: 15.8%), while drug
eluting stent use was highest (32.8%) in Ticino and lowest (13.9%) in
Central Switzerland (Swiss average: 24.0%). Coronary artery bypass
graft rates were highest (4.6%) in Ticino and lowest (0.4%) in Eastern
Switzerland (Swiss average: 2.6%). Mechanical circulatory assistance
rates were highest (4.1%) in Zurich and lowest (0.4%) in Ticino (Swiss
average: 1.7%). The differences in revascularization procedures
remained after adjusting for age, single or multiple hospital
management and gender.
Conclusion: In Switzerland, significant geographical differences in
management and revascularization procedures for AMI were found.