WORLD HEALTH ORGANIZATION PROJECT «ACUTE MYOCARDIAL INFARCTION REGISTRY»: EPIDEMIOLOGICAL MONITORING OF ACUTE CORONARY CATASTROPHES

Abstract

Aim. To assess long-term (1984–2016) trends in the main epidemiological parameters of acute myocardial infarction (AMI) with the World Health Organization Epidemiologic Project “Acute Myocardial Infarction Registry”. Methods. Epidemiology of AMI was estimated among permanent urban residents aged over 20 years. The study was performed according to the standard research approach using unified diagnostic (clinical, electrocardiographic, biochemical, and pathomorphological) criteria. There was a total of 49,606 subjects with suspected AMI enrolled in the study. Of whom, 30,362 patients (61.2%) got their diagnosis validated. Results stimated incidence of AMI before 2004 had a wave-like pattern with an overall upward trend. Its rate increased significantly in the period from 2005 to 2010 compared to that in 2004 (p<0.05). In 2011– 2013, the incidence insignificantly increased to 2.23–2.36 cases per 1,000 residents. The incidence rate has been decreasing since that time. Importantly, this decrease was commonly found in male subjects of all ages. However, these changes were less pronounced in women. The changes in the mortality rates virtually followed the incidence rates during the entire period of the study. The overall mortality in AMI patients inTomsk was 35.98% without any changes until 2000s, when it increased due to higher in-hospital mortality among patients who received treatment in the community hospitals. The mean prehospital mortality from AMI was 21.73%. The prehospital mortality rate gradually decreased from 24.8% to 12.3% (p<0.05) in the period from 2001 to 2016. It should be noted that the proportion of elderly subjects died pre-hospitally was the same as those of young adults. Conclusion The 30-year-follow-up suggests that unfavorable epidemiologic situation of AMI is mainly associated with its incidence rates among patients over 60 years.