Time trends in the treatment of acute myocardial infarction in Switzerland from 1986 to 1993: do they reflect the advances in scientific evidence from clinical trials?

Three acute coronary care surveys (1986, 1990, and 1993) were conducted in the Swiss region of Vaud-Fribourg on all men aged 25 to 64 years hospitalized for a definite myocardial infarction (218, 224, and 167 cases). Nearly all patients received anticoagulants and nitrates. The proportion of patients treated increased significantly, between 1986 and 1990, for antiplatelet drugs (from 51% to 96%) and thrombolytics (from 9% to 44%) and, between 1990 and 1993, for beta-blockers (from 57% to 78%) and angiotensin-converting enzyme inhibitors (from 26% to 43%). The use of calcium antagonists and antiarrhythmics dropped over time. Coronary arteriography and angioplasty were increasingly performed (53% and 18% in 1993), although progressively postponed in-hospital stay. The observed trends reflect a rapid translation of clinical trials into medical practice. However the use of thrombolytics could be raised further by shortening the hospitalization delay (median: 3 hours in 1993) and door-to-needle time (median: 47 minutes) which remained stable over time