Epidemiology Of Acute Myocardial Infarction Research Articles

Characteristics, in-hospital management, and complications of acute myocardial infarction in northern and Central Vietnam

IntroductionContemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited. MethodsWe established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries. ResultsA total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively. ConclusionsThe incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province.

National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

BackgroundDespite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015.Methods and ResultsWe conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively).ConclusionsNational, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

Incidence and mortality of myocardial infarction among Catalonian older adults with and without underlying risk conditions: The CAPAMIS study.

Population-based data about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality of acute myocardial infarction in older adults with specific underlying chronic conditions and evaluated the influence of these conditions in developing acute myocardial infarction. This was a population-based cohort study involving 27,204 individuals ≥ 60 years of age in Tarragona (Catalonia, Spain). Data on all cases of hospitalised acute myocardial infarction were collected from 1 December 2008-30 November 2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses and underlying conditions. Multivariable Cox regression analysis was used to calculate hazard ratios and to estimate the association between baseline conditions and risk of developing acute myocardial infarction. The incidence of acute myocardial infarction was 475 per 100,000 person-years. Maximum rates appeared among individuals with history of coronary artery disease (2839 per 100,000), chronic severe nephropathy (1407 per 100,000), atrial fibrillation (1226 per 100,000), chronic heart disease (1149 per 100,000), history of stroke (1147 per 100,000) and diabetes mellitus (914 per 100,000). Thirty-day mortality was 15.3% overall, reaching 31.6% among patients over 80 years. In the multivariable analysis, history of coronary artery disease, age > 70 years, sex male, chronic heart disease, history of stroke, atrial fibrillation, diabetes mellitus and hypertension emerged as significantly associated with an increased risk of acute myocardial infarction. The incidence and mortality of acute myocardial infarction remain considerable in our setting. Considering classical major risk factors, diabetes mellitus and hypertension were the underlying conditions most strongly associated with an increased risk in our study population.

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

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.

Myocardial infarction at the border of two centuries: demographic and social tendencies

The aim of the study was to compare the incidence, onset, and the course of acute myocardial infarction (AMI) among the population of Tomsk in 1984 and 2013. Materials and Methods: The study was based on the analytic database of the World Health Organization epidemiology program AMI Registry (RAMI). Epidemiology of AMI was studied among the urban population aged 20 years and older. A total of 739 and 983 AMI cases were analyzed in 1984 and 2013 respectively. Results: The proportion ofpatients older than 60 years significantly increased in the age structure of AMI patients during the study period. The occurrence of AMI with atypical clinical onset increased by three times; anamnestic background of AMI worsened; and the number of episodes with preinfarction angina increased. Analysis of the AMIpicture revealed an increase in the occurrence of Q (QS)-wave myocardial infarction and a significant rise in the frequency of complications; the frequency of chronic heart failure, cardiac arrhythmias, and recurrent AMI was especially high. Conclusion: An increase in the proportion of elderly and senile people in the age structure resulted in an aggravation of the diagnostic and prognostic features of AMI during the study period. Evidently, the existing situation requires optimization of medical assistance for patients of older age groups with emphasis on the development and the implementation of recommendations concerning the prediction, diagnosis, treatment, and rehabilitation of these patients.

Incidencia y mortalidad por infarto agudo de miocardio en la población mayor de 60 años del área de Tarragona

Population-based data available about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality from infarction among the general population over 60 years in Tarragona. Cohort study that included 27,204 individuals ≥60 years assigned to nine Primary Care Centers in the Tarragones county (Catalonia, Spain), who were prospectively followed between 01/12/2008 and 30/11/2011. During follow-up, all presumptive episodes of infarction were recruited among cohort members, but only confirmed cases (electrocardiogram and biomarkers confirmation) were included. There were an amount of 359 confirmed episodes of infarction, which means a global incidence rate of 475 episodes per 100,000 person-years (95% CI: 428-527). Incidence was 681 in men and 311in women (p<0.001). According to age, incidence was 277 in 60-69, 632 in 70-79 and 690 per 100,000 in ≥80 years (p<0.001). Incidence was 2,844 cases per 100,000 person-years among those persons whom had history of prior coronary artery disease. Overall 30-day mortality rate was 15.3%, in male 14.9% and in female 16.0% (p=0.776). Incidence was 2.2 times higher in men than in woman and increased considerable by age. It was greater among patients with prior history of coronary artery disease. Mortality was slightly lower in men than in women.

Perfil clínico e resultados da intervenção coronária percutânea primária em pacientes jovens

BackgroundThe epidemiology of acute myocardial infarction with ST‐segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30‐day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI). MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011. ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein‐cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre‐intervention was similar, young people showed higher prevalence of myocardial blush 3 pre‐procedure. The door‐to‐balloon time was lower in younger patients (1.0 hour [0.8‐1.4 hour] vs. 1.3 hour [0.9‐1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07). ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30‐day mortality of these patients was very low.

Clinical profile and outcomes of primary percutaneous coronary intervention in young patients

BackgroundThe epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI). MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011. ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07). ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low.

Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions

Objectives To describe the characteristics and outcome of patients with acute myocardial infarction (AMI) in a community, with particular emphasis on those who never reached a Coronary Care Unit (CCU) and those in whom the primary diagnosis was something other than a heart attack. Methods Patients hospitalised in the city of Göteborg, Sweden, and discharged (dead or alive) with a diagnosis of AMI. Results Among 1423 patient admissions the mean overall age was 75 years (81 years and 79 years in the two subsets). Among all patients, 33% had a history of heart failure and 20% had a history of cerebrovascular disease. The figures were even higher in the two subsets which were evaluated. In overall terms, an invasive strategy (coronary angiography) was used in 32% (in 5% and 9% in the two subsets respectively). The overall one-year and three-year mortality rate was 30% and 44% respectively. The three-year mortality rate among patients not admitted to a CCU was 65% and, among patients with no suspicion of a heart attack on admission, it was 68%. Conclusion Even in the 21st century, patients with AMI who reach hospital alive run a high risk of death and nearly half are dead within the first three years. In overall terms, patients are characterised by high age and high co-morbidity. Among patients who do not reach a CCU and among patients with no suspicion of AMI on admission, approximately two thirds are dead within the subsequent three years.

Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: the first report from Iran

Few data exist about the clinical epidemiology of acute myocardial infarction and its complications and mortality in Iran. To fill this knowledge gap, we studied clinical characteristics and the outcome for a group of Iranian patients with acute myocardial infarction, who were, for the first time in our country, followed after discharge from hospital for 1 year. All patients (139 individuals) with confirmed acute myocardial infarction who were treated at the coronary care unit of Dr Shariati Hospital and followed up over a 1-year period (June 2002 to June 2003) were prospectively studied. Numerous relevant variables including epidemiologic data, treatments received, in-hospital course and complications were recorded. The survivors were followed at 1, 6 and 12 months after discharge. In all, there were 101 men and 38 women aged 58.6+/-11.8 years. Only 35.9% of patients received thrombolytic therapy, and primary percutaneous coronary intervention was performed in 6.4% of cases. In-hospital death occurred in 21 of 139 (15.1%), with an equal distribution between the two sexes. One-month, 6-month and 12-month cumulative mortality rates were 17.3, 20.1 and 21.6%, respectively. Although our patients were younger than myocardial infarction patients in developed countries, they had a higher rate of in-hospital mortality than those of the international statistics. This may be due, in part, to the lower rate of administration of primary reperfusion strategies in our center, namely primary percutaneous coronary intervention and thrombolytic therapy, which have proved to be effective in reducing the mortality from myocardial infarction in the west. Wider application of primary percutaneous coronary intervention, in particular, is recommended.

Epidemiology of acute myocardial infarction in the Italian CCU network: the BLITZ study.

A large number of descriptive data on patients with acute myocardial infarction are based on clinical trials and registries on non consecutive patients: these data may give only a partial picture on treatment delay, patient characteristics, treatment and outcome of acute myocardial infarction in the real world. The BLITZ survey prospectively enrolled all of the patients with acute myocardial infarction admitted in 296 (87%) Italian Coronary Care Units from 15-29 October 2001. Data on treatment delay, therapeutic strategies, duration of hospitalization and 30-day outcome were collected. One thousand nine hundred and fifty-nine consecutive patients (mean age 67+/-12 years, 70% males) were enrolled, 65% with ST-segment elevation (STEMI), 30% with no ST-segment elevation (NSTEMI) and 5% with undetermined ECG. The median delay between symptom onset and hospital arrival was 2h and 9 min with 76% of patients hospitalized within the sixth hour (26% within the first hour, 48% within the second). The median delay from hospital arrival to reperfusion therapy in STEMI was 45 min (IQR 26-85) for thrombolysis (50% of the patients) and 85 min (IQR 60-135) for primary angioplasty (15% of the patients). Coronary angiography was performed during hospital stay in 46% of the patients (STEMI 48%, NSTEMI 43%, undetermined AMI 35%), coronary angioplasty in 25% (STEMI 26%, NSTEMI 15%, undetermined AMI 13%) and coronary bypass in 1.4% (1%, 2.2% and 1% respectively). Twenty-two percent of the patients admitted to hospitals without cath-lab were transferred to a tertiary care hospital for invasive procedures. The overall median hospital stay was 10 days (IQR 7-12, STEMI 10, NSTEMI 9, undetermined AMI 11) and was not significantly different between hospitals with or without cath-lab (respectively, 9 and 10 days, P=0.38). After discharge and up to 30 days, coronary angiography was performed in 11% (STEMI 11%, NSTEMI 11%, undetermined MI 9%), angioplasty in 10% (STEMI 10%, NSTEMI 11%, undetermined MI 7%), bypass surgery in 7% (STEMI 5%, NSTEMI 11%, undetermined AMI 7%). The in-hospital and 30-day case fatality rates were 7.4% and 9.4%, respectively (7.5% and 9.5% for STEMI, 5.2% and 7.1% for NSTEMI, 18.2% and 21.2% for undetermined MI). Patients with acute myocardial infarction admitted to the Italian CCUs, are older than those represented in clinical trials. A high proportion of these cases has the chance to receive early reperfusion therapy. Short-term mortality is lower than expected for patients with STEMI, but higher than reported for NSTEMI.

Clinical epidemiology of acute myocardial infarction in Sharjah, United Arab Emirates

Little published information about the clinical epidemiology of acute myocardial infarction (AMI) in the United Arab Emirates (UAE) is available. To fill this knowledge gap, all patients with confirmed AMI who were treated at the intensive care unit of the Kuwait Hospital, Sharjah, during 1991 were prospectively studied. This hospital, primarily for expatriate patients, provides outpatient and hospital care to expatriates for a nominal fee and to UAE citizens free of charge. It is estimated that about 80% of all expatriate AMI patients in Sharjah receive initial treatment at this hospital. Of all 153 patients studied, 95.4% were men and 4.6% were women. Preexisting ischaemic heart disease, hypertension and diabetes were recorded in 30.2 (39/129), 17.8 (27/152) and 14.6% (22/151) of the patients, respectively. Overall, 73.7% (112/152) of the patients were current cigarette smokers. Of all 153 patients, 48.4, 35.9, 7.2 and 8.5% had anterior, inferior, lateral and `other' types of AMI, respectively. Of 152 patients with available data, 15 (9.9%) died in the hospital. In a multivariate logistic regression model including all significant univariate correlates of in-hospital death (age, nationality, history of hypertension and current smoking practice) as independent variables, only being a current cigarette smoker was significantly related to a lower risk of in-hospital death in the study patients (O.R.=0.27; 95% C.I.: 0.08–0.96). Also, UAE Arab nationality and preexisting hypertension were notable, though nonsignificant, positive correlates of in-hospital death in this model. These finding should guide future in-depth studies of the clinical epidemiology of AMI in Sharjah and elsewhere in the UAE.

Myocardial infarction in young adults: Risk factors and clinical features

To define the risk factors and clinical presentation of patients under age 40 who present to the emergency department (ED) of a community hospital with an acute myocardial infarction (MI), a retrospective cross-sectional study was conducted over a 7-year period. Two hundred and nine consecutive cases of initial MI who met World Health Organization criteria (chest pain, ECG changes, and serum enzyme rises) and were admitted to one of five participating hospitals were reviewed. The mean age of patients was 34.8 years (range, 17–39); 81% were male. The major risk factor was tobacco use (81%), followed by family history (40%), hypertension (26%), and hyperlipidemia (20%). One hundred and eighty-three patients (87.6%) had ECG evidence of cardiac ischemia, injury, or infarction in the ED. Approximately 24% of patients had multi-vessel coronary atherosclerosis as documented by angiography; 62% had single vessel disease; and 14% had normal coronary arteries. The most common anatomical location for the MI was the inferior wall. This study characterized the epidemiology of acute MI in young adults: 1) smoking emerged as the main coronary risk factor; 2) atherosclerosis continues to be the major etiology; 3) a common finding on angiography was single-vessel disease causing infarction of the inferior wall; and 4) the complication rate was comparable to older populations, but the inhospital mortality was only 1.9%.