(Circulation. 1997;96:3849-3859.)
© 1997 American Heart Association, Inc.
Articles |
Population Versus Clinical View of Case Fatality From Acute Coronary Heart Disease
Results From the WHO MONICA Project 1985–1990
From the Institute of Epidemiology and Social Medicine, University of Münster (Germany) (L.C., U.K.); the Department of Biostatistics, University of North Carolina, Chapel Hill (L.C.); GSF-Institute of Epidemiology, Neuherberg, Germany (U.K., H.L.); Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, NSW, Australia (A.D.); MONICA Data Centre, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (M.M., K.K., A.-M.R.); and the Cardiovascular Epidemiology Unit, MONICA Quality Control Centre for Event Registration, University of Dundee (Scotland) (H.T.-P.).
Correspondence to Dr Ulrich Keil, Institute of Epidemiology and Social Medicine, University of Münster, Domagkstr. 3, D-48129 Münster, Germany. E-mail Keilu{at}uni-muenster.de
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionAppendix 1References |
|---|
Background The clinical view of case fatality (CF) from acute myocardial infarction (AMI) in those reaching the hospital alive is different from the population view. Registration of both hospitalized AMI cases and out-of-hospital coronary heart disease (CHD) deaths in the WHO MONICA Project allows both views to be reconciled. The WHO MONICA Project provides the largest data set worldwide to explore the relationship between CHD CF and age, sex, coronary event rate, and first versus recurrent event.
Methods and Results All 79 669 events of definite AMI or possible coronary death, occurring from 1985 to 90 among 5 725 762 people, 35 to 64 years of age, in 29 MONICA populations are the basis for CF calculations. Age-adjusted CF (percentage of CHD events that were fatal) was calculated across populations, stratified for different time periods, and related to age, sex, and CHD event rate. Median 28-day population CF was 49% (range, 35% to 60%) in men and 51% (range, 34% to 70%) in women and was particularly higher in women than men in populations in which CHD event rates were low. Median 28-day CF for hospitalized events was much lower: in men 22% (range, 15% to 36%) and in women 27% (range, 19% to 46%). Among hospitalized events CF was twice as high for recurrent as for first events.
Conclusions Overall 28-day CF is halved for hospitalized events compared with all events and again nearly halved for hospitalized 24-hour survivors. Because approximately two thirds of 28-day CHD deaths in men and women occurred before reaching the hospital, opportunities for reducing CF through improved care in the acute event are limited. Major emphasis should be on primary and secondary prevention.
Key Words: coronary disease • epidemiology • population • registries • MONICA Project • myocardial infarction
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
Coronary heart disease (CHD) mortality rates vary markedly between countries,1,2 reflecting both the variation in incidence and case fatality (CF). The WHO MONICA Project (Multinational MONItoring of Trends and Determinants in CArdiovascular Disease)3 has collected data continuously on all suspected cases of acute myocardial infarction (AMI) or coronary death over a 10-year period using population-based registers of acute coronary events. Many studies have considered CF only for hospitalized AMI cases. An important advantage of the MONICA Project's population-based registers is that the population view of CF can be obtained as all acute episodes of CHD, including those resulting in death out of the hospital, can be identified, thus considerably increasing the estimated percentage of CHD events that are fatal. The MONICA database also provides an opportunity to study the relationship between CF and coronary event rate for 29 populations. The large numbers of events in widely differing populations allow the examination of CF by different time periods (out of hospital, in hospital) and for first and recurrent event and permit an integration of the clinical and population view of CF.4–8 The long-debated potential differences in CF between men and women can also be addressed by analysis of CF by sex and age.9–11
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
The registration methods used have been described previously.5,6 All suspected acute coronary events, including out-of-hospital coronary deaths, in people 35 to 64 years of age, have been registered in a standardized way. Nonfatal events have been classified into one of the MONICA diagnostic categories on the basis of coding of reported symptoms, enzyme levels, and ECG findings.5,6 For fatal events, necropsy findings, if any, and history of CHD have also been used to determine the MONICA diagnosis. Detailed criteria and quality assurance procedures for event registration have been published.5 For this cross-sectional study, all coronary events in either of the following categories have been included5,6: (1) nonfatal definite AMI (NF1) according to MONICA diagnostic criteria and (2) deaths satisfying the MONICA definitions for fatal definite AMI (F1), possible coronary death (F2), or unclassifiable (F9) (called insufficient data in the manual6).
Thus all 79 669 events of definite AMI (NF1) or coronary death
(F1,2,9) occurring from 1985 to 1990 among 5 725 762 people, 35 to 64
years of age, are the basis for CF calculations. Data from 29
populations that met data quality criteria by October 1995 were used
(Table 1
). (Nine of 38 populations in the
MONICA Project were excluded from this report: Registration of
fatal events was incomplete in three populations; in one population,
data were inadequate to estimate CF; one had not registered events for
enough years; the quality of survival time data were insufficient in
two; and two had errors in coding events as hospitalized. Data are for
the years 1985 to 1990 except for Bremen, Germany (1985–1989), Friuli,
Italy (1985–1989), and Northern Sweden (1986–1990).
|
Definitions of Case Fatality
Events have been classified into four groups according to
survival: group 1 (G1), prehospital deaths, ie, persons who died before
hospitalization; group 2 (G2), patients who were hospitalized and died
within the first 24 hours after onset of symptoms; group 3 (G3),
patients who were hospitalized and survived the first 24 hours but died
within 28 days from onset of symptoms; and group 4 (G4), patients who
were hospitalized and survived 28 days after onset of symptoms.
From these groups, five definitions of CF are derived (Table 2). These vary both in terms of the end
of the period of observation, 24 hours or 28 days, and the beginning,
considering all events, only hospitalized events, or only hospitalized
events where the person survived 24 hours after onset of symptoms. CF
was defined as the number of fatal events as a percentage of the total
number of fatal plus nonfatal events.
|
Coronary events are classified as first or recurrent AMI using information about history of previous AMI. Although this information is available for most hospitalized events, it is frequently lacking for prehospital deaths. Therefore, CF for first versus recurrent event is analyzed only in hospitalized events and those with unknown history of previous AMI were omitted from the calculations.
Age Standardization
Direct age standardization of the event rates and the mortality
rates was done according to the procedures of the WHO MONICA
Project,2,6 using the truncated Segi world
standard population weights 6, 6, 6, 5, 4, and 4 for the 5-year age
groups from 35 to 39, to 60 to 64 years,
respectively.12
Age-standardized CF was calculated with direct standardization for the
10-year age groups 35 to 44, 45 to 54, and 55 to 64 years, with weights
of 1, 3, and 7, on the basis of the age distribution of events for the
WHO MONICA Project as a whole. The age-standardized CF for a
population is given by
100(
wi[di/ei]),
where i=1, 2, 3 indicates the age groups, wi
denotes the weight, ei is the number of events,
fatal and nonfatal, occurring in age group i for that population, and
di is the number of fatal events. Approximate
95% confidence intervals are given by
100wi(di/ei)±1.96
SE, where
SE2=1002(wi2di[ei-di]/ei3).
Statistical Analysis
The relationships between CF and CHD event rates or age were
explored by means of graphs and simple linear regression, separately
for men and women. Sex differences in CF were analyzed by use
of women-to-men CF ratios as the dependent variable (to focus on
relative as opposed to absolute differences) and age and event rates as
possible explanatory variables. The analysis of the
variation of age-specific CF was mainly graphical.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
Table 1
describes the 29 populations in terms of mean population
sizes, numbers of fatal and nonfatal CHD events, CHD event rates (fatal
plus nonfatal), and CHD mortality rates for the age group 35 to 64
years in 1985 to 1990. The age-standardized CHD mortality rates (fatal
events per 100 000 persons per year) based on the MONICA registers had
an enormous range, from 46 in Beijing (China) to 395 in North Karelia
(Finland) for men and from 15 in Catalonia (Spain) to 127 in Glasgow
(UK) for women. The CHD event rates ranged from 79 to 818 for men and
from 33 to 267 for women.
Fig 1 shows sex-specific age-adjusted
percentages of all 28-day CHD deaths that occurred before
hospitalization; in the hospital within 24 hours after onset of
symptoms; and between 24 hours and 28 days after onset of symptoms,
among hospitalized events. For women, 42% to 75% (median 64%) of all
CHD deaths within 28 days occurred before reaching the hospital. This
was somewhat lower than for men, for whom the range was 58% to 80%
(median, 70%). Moreover, this percentage was lower for women than for
men in 22 of the 29 populations.
|
Tables 3 and 4 show age-adjusted CF by various stages
of the acute event. Among hospitalized events, 28-day CF was 15% to
36% (median, 22%) for men and 19% to 46% (median, 27%) for women.
However, when prehospital events were included, overall 28-day CF was
substantially higher: 35% to 60% (median, 49%) for men and 34% to
70% (median, 51%) for women. Hospitalized patients who survived 24
hours after onset of symptoms had much lower 28-day CF: 8% to 21%
(median, 14%) for men and 11% to 30% (median, 16%) for women.
Age-adjusted 24-hour CF was 29% to 51% (median, 41%) for men and
22% to 60% (median, 42%) for women.
|
|
Age-adjusted 28-day CF for hospitalized events was higher for women than men in all 29 populations, by as much as an absolute 12%. However, prehospital CF was higher for women in only 13 populations. The combination of these different periods resulted in age-adjusted overall 28-day CF being higher for women in 21 out of 29 populations.
Fig 2 shows age-adjusted CF by several
definitions plotted against age-adjusted CHD event rate over the 29
populations by sex. For 28-day CF, there is no relationship for men and
a negative relationship for women. For example, by linear regression it
was estimated that for populations with an age-adjusted
coronary event rate 50 per 100 000 higher, the age-adjusted
28-day CF for women would be an absolute 4.3% lower
(P=.03). The relationship remained negative and
statistically significant for women for all other definitions of CF
except in 28-day CF for hospitalized 24-hour survivors. For men there
was no association with event rate for any definition of CF. The graphs
show that the strong relationship observed for women between 28-day CF
and CHD event rate was mainly due to an association between 24-hour CF
and CHD event rate.
|
The unadjusted and age-adjusted ratios of CF for women to CF for
men are shown in Table 5 for 28-day CF
and in Table 6 for 28-day CF for
hospitalized events. The ratios were all larger than unity for
hospitalized events (median, 1.32); they were always smaller for
overall 28-day CF (median, 1.09) than for 28-day CF for hospitalized
events. These ratios were generally reduced by age adjustment, but even
then the sex ratios in 28-day CF for hospitalized events remained
>1.20 and statistically significant for over half the populations
(median, 1.24).
|
|
There were statistically significant inverse associations between the
women-to-men ratios of age-adjusted CF and the mean (men and women
combined) age-adjusted CHD event rates for all definitions of CF (Fig 3).
|
Fig 4 depicts the mean (all
populations) 28-day CF with 95% CI, by 5-year age groups, for men and
women. In men, the mean CF decreased from the 35-to 39-year age group
to the next by an absolute 3% (P=.26 by t test).
There was little change to the next 5-year age group, but from the 45-
to 49-year to the 60- to 64-year age group, there was a 5% to 7%
absolute increase in CF with each 5-year age group (each with
P<.02). Although the shape of the curve for women is
similar to that of men, the increase between age groups 40 to 44 and 50
to 54 was small. Between age groups 35 to 39 and 40 to 44, the mean
decrease was an absolute 5% (P=.25) and between age groups
55 to 59 and 60 to 64, the mean increase was 6% (P=.03).
Further, CF was higher for women than men in 22 of the 29 populations
at age 40 to 49 years, with a mean CF of 39% for men and 49% for
women. However, in the 55- to 64-year age group the mean 28-day CF was
nearly identical for men and women, being 54% and 55%,
respectively.
|
Table 7 shows CF for hospitalized events
for known first AMI and for known recurrent AMI. The percentage of
events for which AMI history was unknown was 0% to 33% (median, 2%)
for men and 0% to 38% (median, 2%) for women. Events for which the
determination of first versus recurrent could not be made were
excluded. CF was about twice as high for recurrent events as for first
events. The median of ratios of recurrent event to first event for
28-day CF for hospitalized cases was 2.1 for men and 1.7 for women.
(These are medians of the individual population ratios [not shown],
not ratios of the medians.) The medians of these ratios for
hospitalized cases who survived 24 hours were 2.2 and 1.9 for men and
women, respectively. Women-to-men ratios for 28-day CF were higher for
first than recurrent events: 1.34 and 1.17, respectively, for all
hospitalized cases, and 1.44 and 1.26, respectively, for hospitalized
24-hour survivors.
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
The value of international comparative studies such as this depends on the extent to which the data are truly comparable. Collection of carefully defined data items, standardized diagnostic criteria, and regular quality assessment in the WHO MONICA Project are strengths of the present study. Once a coronary event is registered and diagnostic information collected, the classification of nonfatal events is likely to be the same in all centers, provided that the proportion of missing data for the diagnostic variables (symptoms, ECGs, and cardiac enzymes) is small. Similarly, with complete information for fatal events on history of CHD, symptoms, and necropsy findings, classification of the events is likely to be similar at all centers. However, the percentage of fatal events with unclassifiable data was
25% higher for women than men and was inversely associated with CHD
event rate.5 The assessment of sex differences in CF has received much attention9 but is greatly affected by the choice of definitions and by whether the study is population based or hospital based. Vaccarino et al9 reviewed 27 studies of sex differences in 1-month CF for hospitalized AMI events (with sufficient enzyme or ECG data to ascertain AMI). They found higher CF levels in women than in men in all but one study. Since mean age is greater for women CHD patients than for men, and CF is associated with age, it would be expected that age adjustment would reduce these differences. Indeed, in the 11 studies that presented both unadjusted and age-adjusted results, the age adjustment reduced the women-to-men ratio of CF to <1.2 and statistical nonsignificance in all but two studies. Although the age adjustment did generally reduce the sex differences in the 29 MONICA populations, the women-to-men ratio of 28-day CF for hospitalized events remained >1.2 and statistically significant in over half of the populations. In the MONICA populations, the women-to-men ratios of overall 28-day CF (including CHD deaths occurring before hospitalization) are closer to those reported by Vaccarino et al, namely <1.2 and statistically significant for only 5 of the 29 populations.
For both men and women, CF was higher in the 35- to 39-year age group than in the 40- to 44-year age group, reflecting either more severe disease or slower recognition and treatment of younger CHD patients. The difference between men and women in overall 28-day CF almost vanished by age 55 to 64 years, indicating the need for qualifying the statement that women have higher CF than men.
The WHO MONICA Project has also shown that in men CF was not related to the absolute magnitude of the CHD event rates in a population, but in women CF decreased with increasing CHD event rates. An interpretation of these differences is that some nonfatal AMI events are missed in populations with very low CHD event rates for women.5 A recent paper from the Glasgow MONICA center,11 which has high event rates and fairly complete data on previous CHD for out-of-hospital deaths, did not find significant CF differences between men and women at any age for overall 28-day CF, supporting the suggestion that higher CF for women in other populations could be due to failure to recognize nonfatal AMI cases. The Scottish paper however, as here, showed a significantly lower percentage of 28-day deaths in women than in men occurring before hospitalization and a significant excess of deaths afterward. More higher-risk women than men are surviving long enough to reach the hospital alive. This is why CF for hospitalized cases is higher in women than in men.11
The CF differences shown here between the several definitions serve to highlight the difference between population-based studies, which include prehospital deaths, and hospital-based studies, ie, the population versus clinical view of CF. Coronary heart disease CF of 40% to 50% is typically reported from community studies of AMI.13,14 In contrast, hospital-based studies that include deaths in emergency rooms and typically use CF definitions similar to ours for hospitalized events obtain CF of about half the size of our overall 28-day CF.15–18 Coronary heart disease CF in cases who survive long enough to have data available on enzymes and ECG, ie, who survive several hours after reaching the hospital, is lower and may be closer to our CF for hospitalized 24-hour survivors.19
The variation across populations was least for overall 28-day CF. This may be due to the fact that other CF definitions are affected by how quickly people get to the hospital or receive thrombolytic therapy and by difficulties in classifying cases who die soon after arrival at the hospital. This also suggests that prehospital CF plus 24-hour CF for hospitalized patients is more valid for cross-population comparisons of early CF than prehospital CF. Variation in CF across populations was least for overall 28-day CF, which suggests that differences between populations in emergency care and transport to the hospital affect time of death rather than overall 28-day CF.
A great advantage of the WHO MONICA Project is its ability to provide both a population and a clinical perspective in the study of CF. In men, a rule of thumb might be that the overall 28-day CF is halved for hospitalized events and again nearly halved for hospitalized 24-hour survivors. This holds even among populations with widely differing 28-day CF. The respective percentages for women are slightly higher but are similar. In light of these population and hospital-based CF data, studies reporting very high survival figures for AMI patients should be put into perspective. They are likely to have investigated acute events rather late in their natural history, eg, when AMI patients have survived at least 24 hours in a coronary care unit.
Of all CHD patients who die within 28 days after onset of symptoms, about two thirds die before reaching hospital, therefore opportunities for reducing CF through improved care during the acute event are limited, emphasizing that the CHD epidemic can best be conquered by strengthening primary and secondary prevention for CHD.
|
Acknowledgments |
|---|
MONICA Centers are funded predominantly by regional and national governments, research councils, and research charities. Coordination is the responsibility of the World Health Organization (WHO), assisted by local fund raising for congresses and workshops. WHO also contributes to the MDC in Helsinki, which is supported by the National Public Health Institute of Finland. A contribution to WHO from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md, provides some support for the MDC and the Quality Control Center for Event Registration in Dundee. Grants from ASTRA Hässle AB, Sweden, Hoechst AG, Germany, Hoffmann-La Roche AG, Switzerland, and the Institut de Recherches Internationales Servier (IRIS), France, support data analysis and preparation of publications. The authors would like to thank Esa Ruokokoski at the MDC and Marianna Chambless in Münster/Chapel Hill for their work in the analysis of these data and Carmen Ewe, Münster, for preparing the manuscript.
|
Footnotes |
|---|
1 See "Appendix" for list of participants.
|
Appendix 1 |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
Sites and Key Personnel of Contributing MONICA Centers
Australia
University of Western Australia, Nedlands
M.S.T. Hobbs,4 K.
Jamrozik,4 R.W. Parsons, R. Broadhurst, C.
Spencer, P.L. Thompson
University of Newcastle
A. Dobson,1 S.
Leeder,2 H. Alexander, R. Heller, R. Gibberd, P.
Steele
Canada
Dalhousie University, Halifax, Nova Scotia
R.D. Gregor,1 B.R. Mackenzie, P.M.
Rautaharju, H.K. Wolf1
China
Beijing Heart, Lung, and Blood Vessel Research Institute,
Beijing
W. Zhaosu,1 W.
Yingkai,2 Y. Chonghua, H. Zhaoguang
Denmark
Copenhagen University Hospital, Glostrup
M. Schroll,1 M. Kirchhoff, B. Hansen, S.Q.
Lund, H. Schnack, M. Madsen
Finland
National Public Health Institute, Helsinki
J. Tuomilehto,1 P.
Puska,2 M. Arstila, P. Immonen-Räihä,
E. Kaarsalo, M. Ketonen, S. Lehto, H. Miettinen, H. Mustaniemi, M.
Niemelä, P. Palomäki, K. Pyörälä, M.
Romo, V. Salomaa, J. Torppa, T. Vuorenmaa
France
National Institute of Health and Medical Research (INSERM
U258) Paris
J. Richard,3 A. Bingham
National Institute of Health and Medical Research,
Toulouse
J. Ferrières,1 J.B. Ruidavets, P.
Marqués-Vidal, J.P. Cambou,2 P. Rodier, C.
Saulet
Department of Epidemiology and Public
Health–Faculty of Medicine, Strasbourg
D. Arveiler,1 P.
Schaffer,1 A. Facello, E. MarineBarjoan, E.
Uettwiller, D. Jacques
Pasteur Institute and Study and Research Group on Myocardial
Infarction, Lille
P. Amouyel,1 M.
Montaye-Faivre,1 J.-L.
Salomez,2 M.-C. Nuttens,2
C. Graux, N. Marecaux
Germany
Bremen Institute for Prevention Research and Social
Medicine
E. Greiser,1 B.
Herman,4 G. Stüdemann
GSF-Institute for Epidemiology, Munich
U. Keil,1 H. Löwel, M. Lewis, A.
Hörmann, J. Gostomzyk, H.D. Bolte
Center for Epidemiology and Health
Research, Berlin
W. Barth,4 L.
Heinemann,4 E. Classen, D. Quietzsch, G. Voigt,
S. Brasche, S. Böthig
Iceland
Heart Preventive Clinic, Reykjavik
N. Sigfusson,1 I.I. Gudmundsdottir, I.
Stefansdottir, T. Thorsteinsson, H. Sigvaldason
Italy
National Institute of Health, Rome
A. Menotti,3 S. Giampaoli, A.
Verdecchia
Institute of Cardiology, Regional Hospital,
Udine
G.A. Feruglio,1
D. Vanuzzo, L. Pilotto,
A. Antonini-Canterin, M. Scarpa, G.B. Cignacco, M. Spanghero, M.
Palmieri
Research Center on Chronic Degenerative Diseases of the University
of Milan
G.C. Cesana,1 M.
Ferrario,1 G. De Vito, C. Bravi, M.T. Gussoni, R.
Sega, R. Zanettini, O. Agostoni
Lithuania
Kaunas Medical Academy, Institute of Cardiology
J. Bluzhas,1 V. Grinius, R.
Grazuleviciene, D. Rasteniene, D. Rastenyte
New Zealand
University of Auckland
R. Beaglehole,1 R.T. Jackson, A.W.
Stewart
Poland
National Institute of Cardiology, Warsaw,
Department of Cardiovascular
Epidemiology and Prevention
S. Rywik,1 G. Broda, P. Kurjata, H.
Wagrowska, M. Palakowska, W. Kupsc
Russian Federation
National Research Center for Preventive Medicine, Moscow
T. Varlamova,1 V. Naumova, M. Ossokina, N.
Serdyuchenko, N. Popova, E Bolshakova
Spain
Department of Health and Social Security, Barcelona
S. Sans,1 A. Puigdefàbregas, G.
Paluzie, I. Balaguer-Vintró2
Sweden
Department of Internal Medicine, Kalix Lasarett
F. Huhtasaari,1 V. Lundberg
Umeå University Hospital, Department of Medicine
P.O. Wester
United Kingdom
The Queen's University of Belfast, Northern Ireland
A.E. Evans,1 Z.M. Mathewson, E.E. McCrum,
A. Hall, T. Falconer, E.L. McIlmoyle
University of Dundee, Scotland
H. Tunstall-Pedoe,1 C. Brown, M.
Shewry
Royal Infirmary, Glasgow, Scotland
C. Morrison,4 G.
Watt,5 W. Leslie, B. Fitzpatrick
United States
Stanford Center for Research in Disease Prevention, Stanford,
Calif
S.P. Fortmann,1 M. Winkleby, A. Varady, D.
Jatulis, M. Hull
Yugoslavia
Novi Sad Health Center
M. Planojevi,1 D.
Jakovlevic,2 T. Dapi, D. Stoj
ic, M. Krco,
Z. 
olak
MONICA Management Center-World Health Organization,
Geneva
I.Martin,6 I.
Gyarfas,7 S. Böthig,7
Z. Pisa,7 S.R.A. Dodu,7
M.J. Watson, M. Hill
MONICA Data Center–National Public Health Institute,
Helsinki, Finland
K. Kuulasmaa,6 J.
Tuomilehto,7 A.-M. Rajakangas, E. Ruokokoski, V.
Moltchanov, J. Torppa, M. Mähönen
MONICA Quality Control Center for ECG Coding–Hungarian Institute
of Cardiology, Budapest
P. Ofner,6 A.
Madai7
MONICA Quality Control Center for Event Registration, University of
Dundee, Scotland
H. Tunstall-Pedoe,6 K. Barrett, C.
Brown
MONICA Steering Committee
A. Evans (Chair), M. Hobbs (Chair, Publications Subcommittee),
M. Ferrario, H. Tunstall-Pedoe (Rapporteur), K. Kuulasmaa, A.
Shatchkute, (WHO, Copenhagen), I. Martin (WHO HQ, Geneva)
Consultants: A. Dobson, Z. Pisa, O.D. Williams
Previous Members of Steering Committee: S. Sans, F. Gutzwiller, R. Beaglehole, U. Keil, S.L. Rywik, S.P. Fortman, P. Puska, A. Menotti. Former Chiefs of CVD/HQ: V. Zaitsev (WHO, Copenhagen), J. Tuomilehto
Former Consultants: M.J. Karvonen (Helsinki, Finland), R.J.
Prineas (Minneapolis, Minn); M. Feinleib (Bethesda, Md); F.H.
Epstein (Zürich, Switzerland)
1Principal Investigator
2Former Principal Investigator
3Country Coordinator
4Co-Principal Investigator
5Former Co-Principal Investigator
6Responsible Officer
7Former Responsible Officer
Received June 30, 1997; revision received August 22, 1997; accepted August 29, 1997.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
|---|
1. Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q. 1988;41:155–178.[Medline] [Order article via Infotrieve]
2. WHO MONICA Project, by Tuomilehto J, Kuulasmaa K, Torppa J. WHO MONICA Project: Geographic variation in mortality from cardiovascular diseases. World Health Stat Q. 1987;40:171–184.[Medline] [Order article via Infotrieve]
3. WHO MONICA Project, by Tunstall-Pedoe H. The World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular disease): a major international collaboration. J Clin Epidemiol. 1988;41:105–114.[Medline] [Order article via Infotrieve]
4.
Löwel H, Dobson A, Keil U, Herman B, Hobbs MST,
Stewart A, Arstila M, Miettinen H, Mustaniemi H, Tuomilehto J.
Coronary heart disease case fatality in four countries.
Circulation. 1993;88:2524–2531.
5.
WHO MONICA Project, by Tunstall-Pedoe H, Kuulasmaa
K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction
and coronary deaths in the World Health Organization MONICA
Project: registration procedures, event rates, and case-fatality
rates in 38 populations from 21 countries in four continents.
Circulation. 1994;90:583–612.
6. WHO MONICA Project, MONICA Manual. Revised ed. Geneva, Switzerland: Cardiovascular Diseases Unit, World Health Organization; 1990.
7. Barth W, Löwel H, Lewis M, Classen E, Herman B, Quietzsch D, Greiser E, Keil U, Heinemann L, Voigt G, Brasche S, Böthig S. Coronary heart disease mortality, morbidity, and case fatality in five East and West German cities 1985–1989. J Clin Epidemiol. 1996;49:1277–1284.[Medline] [Order article via Infotrieve]
8.
Sonke GS, Beaglehole R, Stewart AW, Jackson R, Stewart
FM. Sex differences in case fatality before and after admission to
hospital after acute cardiac events: analysis of community
based coronary heart disease register. BMJ. 1996;313:853–855.
9.
Vaccarino V, Krumholz HM, Berkman LF, Horwitz
RI. Sex differences in mortality after myocardial infarction: is there
evidence for an increased risk for women? Circulation. 1995;91:1861–1871.
10. Keil U, Chambless L. Sex differences in mortality after myocardial infarction: is there evidence for an increased risk for women? Circulation. 1995;92:3576–3577. Letter.
11.
Tunstall-Pedoe H, Morrison C, Woodward M, Fitzpatrick
B, Watt G. Sex differences in myocardial infarction and
coronary deaths in the Scottish MONICA population of Glasgow
1985–91: presentation, diagnosis, treatment, and 28-day
case fatality of 3991 events in men and women. Circulation. 1996;93:1981–1992.
12. Doll R, Muir C, Waterhouse J. Cancer Incidence in Five Continents. Berlin, Germany: Springer; 1970.
13. WHO Regional Office for Europe. Myocardial Infarction Community Registers. Results of a WHO International Collaborative Study, coordinated by Regional Office for Europe. Public Health in Europe No. 5. Copenhagen: 1976.
14. Gillum RF, Folsom A, Luepker RV, Jacobs DR, Kottke TE, Gomez-Martin O, Prineas RJ, Taylor HL, Blackburn H. Sudden death and acute myocardial infarction in a metropolitan area, 1970–1980: the Minnesota Heart Survey. N Engl J Med. 1983;309:1353–1358.[Abstract]
15.
Sahasakul Y, Chaithiraphan S, Panchavinnin P, Jootar P,
Thongtang V, Srivanasont N, Charoenchob N, Kangkagate C.
Multivariate analysis in the prediction of
death in hospital after acute myocardial infarction. Br
Heart J. 1990;64:182–185.
16. Nidorf SM, Parsons RW, Thompson PL, Jamrozik KD, Hobbs MST. Reduced risk of death at 28 days in patients taking a ß blocker before admission to hospital with myocardial infarction. BMJ. 1990;300:71–74.
17.
McGovern PG, Folsom AR, Sprafka JM, Burke GL, Doliszny
KM, Demirovic J, Naylor JD, Blackburn H. Trends in survival of
hospitalized myocardial infarction patients between 1970 and 1985: the
Minnesota Heart Survey. Circulation. 1992;85:172–179.
18. De Vreede JJM, Gorgels APM, Verstraaten GMP, Vermeer F, Dassen WRM, Wellens HJJ. Did prognosis after acute myocardial infarction change during the past 30 years? A meta-analysis. J Am Coll Cardiol. 1991;18:698–706.[Abstract]
19. Gheorghiade M, Anderson J, Rosman H, Lakier J, Velardo B, Goldberg D, Friedman A, Schultz L, Tilley B, Goldstein S. Risk identification at the time of admission to coronary care unit in patients with suspected myocardial infarction. Am Heart J. 1988;116:1212–1217.[Medline] [Order article via Infotrieve]
This article has been cited by other articles:
 |
|
 |
|
  A. Settin, R. ElBaz, A. Abbas, A. Abd-Al-Samad, and A. Noaman Angiotensin-converting enzyme gene insertion/deletion polymorphism in Egyptian patients with myocardial infarction Journal of Renin-Angiotensin-Aldosterone System, June 1, 2009; 10(2): 96 - 100. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Patel Cardiovascular risk: who should we treat, and how much should we stratify? Heart, May 1, 2009; 95(10): 783 - 784. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Erbel, J. A.C. Delaney, N. Lehmann, R. L. McClelland, S. Mohlenkamp, R. A. Kronmal, A. Schmermund, S. Moebus, N. Dragano, A. Stang, et al. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR) Eur. Heart J., November 2, 2008; 29(22): 2782 - 2791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Fornari, G C Cesana, L E Chambless, G Corrao, R Borchini, F Madotto, M M Ferrario, and for the MONICA Brianza-CAMUNI Research Group Time trends of myocardial infarction 28-day case-fatality in the 1990s: is there a contribution from different changes among socioeconomic classes? J Epidemiol Community Health, July 1, 2008; 62(7): 593 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Drews, P. Picciano, J. Agutter, N. Syroid, D. R. Westenskow, and D. L. Strayer Development and Evaluation of a Just-in-Time Support System Human Factors: The Journal of the Human Factors and Ergonomics Society, June 1, 2007; 49(3): 543 - 551. [Abstract] [PDF]
|
|
|
|
|
|
P. J. Gheeraert, M. L. De Buyzere, Y. M. Taeymans, T. C. Gillebert, J. P.S. Henriques, G. De Backer, and D. De Bacquer Risk factors for primary ventricular fibrillation during acute myocardial infarction: a systematic review and meta-analysis Eur. Heart J., November 1, 2006; 27(21): 2499 - 2510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. V.S. Bonarjee, A. Rosengren, S. M. Snapinn, M. K. James, K. Dickstein, and on behalf of the OPTIMAAL study group Sex-based short- and long-term survival in patients following complicated myocardial infarction Eur. Heart J., September 2, 2006; 27(18): 2177 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. George, G.-H. Yi, A. R. Schulman, B. T. Morrow, Y. Cheng, A. Gu, G. Zhang, M. C. Oz, D. Burkhoff, and J. Wang A polymerized bovine hemoglobin oxygen carrier preserves regional myocardial function and reduces infarct size after acute myocardial ischemia Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1126 - H1137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Simon, M. Mary-Krause, J.-P. Cambou, G. Hanania, P. Gueret, J.-M. Lablanche, D. Blanchard, N. Genes, N. Danchin, and on behalf of the USIC Investigators Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women: Results from the French nation-wide USIC registries Eur. Heart J., June 1, 2006; 27(11): 1282 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Kolovou, K. K. Anagnostopoulou, D. P. Mikhailidis, D. B. Panagiotakos, N. D. Pilatis, M. A. Cariolou, N. Yiannakouris, D. Degiannis, G. Stavridis, and D. V. Cokkinos Association of Apolipoprotein E Genotype with Early Onset of Coronary Heart Disease in Greek Men Angiology, November 1, 2005; 56(6): 663 - 670. [Abstract] [PDF]
|
|
|
|
 |
|
 A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. C Lampe, R. W Morris, M. Walker, A G. Shaper, and P. H Whincup Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men BMJ, May 7, 2005; 330(7499): 1046. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K F Carruthers, O H Dabbous, M D Flather, I Starkey, A Jacob, D MacLeod, K A A Fox, and on behalf of the GRACE Investigators Contemporary management of acute coronary syndromes: does the practice match the evidence? The global registry of acute coronary events (GRACE) Heart, March 1, 2005; 91(3): 290 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P de Jaegere, P. W Serruys, and M. L Simoons Should all patients with an acute myocardial infarction be referred for direct PTCA? Heart, November 1, 2004; 90(11): 1352 - 1357. [Full Text] [PDF]
|
|
|
|
 |
|
 I. Thorsdottir, B. E. Birgisdottir, S. Halldorsdottir, and R. T. Geirsson Association of Fish and Fish Liver Oil Intake in Pregnancy with Infant Size at Birth among Women of Normal Weight before Pregnancy in a Fishing Community Am. J. Epidemiol., September 1, 2004; 160(5): 460 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Engstrom, B. Hedblad, L. Stavenow, P. Tyden, P. Lind, L. Janzon, and F. Lindgarde Fatality of Future Coronary Events Is Related to Inflammation-Sensitive Plasma Proteins: A Population-Based Prospective Cohort Study Circulation, July 6, 2004; 110(1): 27 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K H Mak, J D Kark, K S Chia, L L Sim, B H Foong, Z P Ding, R Kam, and S K Chew Ethnic variations in female vulnerability after an acute coronary event Heart, June 1, 2004; 90(6): 621 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. McIntyre Vasopressin in Asystolic Cardiac Arrest N. Engl. J. Med., January 8, 2004; 350(2): 179 - 181. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Stevens, R. L. Coleman, A. I. Adler, I. M. Stratton, D. R. Matthews, and R. R. Holman Risk Factors for Myocardial Infarction Case Fatality and Stroke Case Fatality in Type 2 Diabetes: UKPDS 66 Diabetes Care, January 1, 2004; 27(1): 201 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.-C. Chang, P. Kaul, C. M. Westerhout, M. M. Graham, Y. Fu, T. Chowdhury, and P. W. Armstrong Impact of Sex on Long-term Mortality From Acute Myocardial Infarction vs Unstable Angina Arch Intern Med, November 10, 2003; 163(20): 2476 - 2484. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Salomaa, M. Ketonen, H. Koukkunen, P. Immonen-Raiha, T. Jerkkola, P. Karja-Koskenkari, M. Mahonen, M. Niemela, K. Kuulasmaa, P. Palomaki, et al. Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland: The FINAMI Study Circulation, August 12, 2003; 108(6): 691 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Natarajan, Y. Liao, G. Cao, S. R. Lipsitz, and D. L. McGee Sex Differences in Risk for Coronary Heart Disease Mortality Associated With Diabetes and Established Coronary Heart Disease Arch Intern Med, July 28, 2003; 163(14): 1735 - 1740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Gunnarsdottir, B. E Birgisdottir, I. Thorsdottir, V. Gudnason, and R. Benediktsson Size at birth and coronary artery disease in a population with high birth weight Am. J. Clinical Nutrition, December 1, 2002; 76(6): 1290 - 1294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Capucci, D. Aschieri, M. F. Piepoli, G. H. Bardy, E. Iconomu, and M. Arvedi Tripling Survival From Sudden Cardiac Arrest Via Early Defibrillation Without Traditional Education in Cardiopulmonary Resuscitation Circulation, August 27, 2002; 106(9): 1065 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-K. Wong and H.D. White Has the mortality rate from acute myocardial infarction fallen substantially in recent years? Eur. Heart J., May 1, 2002; 23(9): 689 - 692. [Full Text] [PDF]
|
|
|
|
|
|
B. Kuch, H.-D. Bolte, A. Hoermann, C. Meisinger, and H. Loewel What is the real hospital mortality from acute myocardial infarction?. Epidemiological vs clinical view Eur. Heart J., May 1, 2002; 23(9): 714 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Vakili, R. C. Kaplan, and D. L. Brown Sex-Based Differences in Early Mortality of Patients Undergoing Primary Angioplasty for First Acute Myocardial Infarction Circulation, December 18, 2001; 104(25): 3034 - 3038. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Barbaux, S. Blankenberg, H. J. Rupprecht, C. Francomme, C. Bickel, G. Hafner, V. Nicaud, J. Meyer, F. Cambien, and L. Tiret Association Between P-Selectin Gene Polymorphisms and Soluble P-Selectin Levels and Their Relation to Coronary Artery Disease Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1668 - 1673. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Marrugat, M Gil, R Masia, J Sala, R Elosua, J M Anto, and the REGICOR Investigators Role of age and sex in short-term and long term mortality after a first Q wave myocardial infarction J Epidemiol Community Health, July 1, 2001; 55(7): 487 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.P. Maggioni, L. Tavazzi, R. Marchioli, G. Tognoni, F. Avanzini, M.C. Roncaglioni, and GISSI-group Perspectives on n-3 PUFAs: primary prevention, antiarrhythmic effects, congestive heart failure Eur. Heart J. Suppl., June 1, 2001; 3(suppl_D): D106 - D109. [PDF]
|
|
|
|
|
|
P.J Schreiner, M Niemela, H Miettinen, M Mahonen, M Ketonen, P Immonen-Raiha, S Lehto, T Vuorenmaa, P Palomaki, H Mustaniemi, et al. Gender differences in recurrent coronary events. The FINMONICA MI register Eur. Heart J., May 1, 2001; 22(9): 762 - 768. [Abstract] [PDF]
|
|
|
|
|
|
S.N Willich, J Muller-Nordhorn, M Kulig, S Binting, H Gohlke, H Hahmann, K Bestehorn, K Krobot, and H Voller Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease. A prospective cohort study Eur. Heart J., February 2, 2001; 22(4): 307 - 313. [Abstract] [PDF]
|
|
|
|
|
|
A Rosengren, C.-L Spetz, M Koster, N Hammar, L Alfredsson, and M Rosen Sex differences in survival after myocardial infarction in Sweden. Data from the Swedish National Acute Myocardial Infarction register Eur. Heart J., February 2, 2001; 22(4): 314 - 322. [Abstract] [PDF]
|
|
|
|
|
|
W. J PENNY Patient delay in calling for help: the weakest link in the chain of survival? Heart, February 1, 2001; 85(2): 121 - 122. [Full Text]
|
|
|
|
|
|
V. Vaccarino, L. F. Berkman, and H. M. Krumholz Long-term Outcome of Myocardial Infarction in Women and Men: A Population Perspective Am. J. Epidemiol., November 15, 2000; 152(10): 965 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.A.A Fox, D.V Cokkinos, J Deckers, U Keil, A Maggioni, and G Steg The ENACT study: a pan-European survey of acute coronary syndromes Eur. Heart J., September 1, 2000; 21(17): 1440 - 1449. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Zahn, R. Schiele, K. Seidl, T. Kapp, H. G. Glunz, E. Jagodzinski, T. Voigtlander, M. Gottwik, G. Berg, H. Thomas, et al. Acute myocardial infarction occurring in versus out of the hospital: patient characteristics and clinical outcome J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1820 - 1826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Erbel, A Schmermund, S Mohlenkamp, S Sack, and D Baumgart Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis Eur. Heart J., May 1, 2000; 21(9): 720 - 732. [PDF]
|
|
|
|
 |
|
 Tackling myocardial infarction DTB, March 1, 2000; 38(3): 17 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Gottlieb, U Goldbourt, V Boyko, D Harpaz, L Mandelzweig, Z Khoury, S Stern, S Behar, and for the SPRINT and Israeli Thrombolytic Survey Gro Mortality trends in men and women with acute myocardial infarction in coronary care units in Israel. A comparison between 1981-1983 and 1992-1994 Eur. Heart J., February 2, 2000; 21(4): 284 - 295. [Abstract] [PDF]
|
|
|
|
|
|
A Klamann, P Sarfert, V Launhardt, G Schulte, W.H Schmiegel, and M.A Nauck Myocardial infarction in diabetic vs non-diabetic subjects. Survival and infarct size following therapy with sulfonylureas (glibenclamide) Eur. Heart J., February 1, 2000; 21(3): 220 - 229. [Abstract] [PDF]
|
|
|
|
|
|
Z.-X. He, T. D. Hedrick, C. M. Pratt, M. S. Verani, V. Aquino, R. Roberts, and J. J. Mahmarian Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia Circulation, January 25, 2000; 101(3): 244 - 251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Dreyer and J. H. Olsen Risk for Non-smoking-related Cancer in Atherosclerotic Patients Cancer Epidemiol. Biomarkers Prev., October 1, 1999; 8(10): 915 - 918. [Abstract] [Full Text]
|
|
|
|
|
|
V. Vaccarino, L. Parsons, N. R. Every, H. V. Barron, H. M. Krumholz, and The National Registry of Myocardial Infarction 2 P Sex-Based Differences in Early Mortality after Myocardial Infarction N. Engl. J. Med., July 22, 1999; 341(4): 217 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Marrugat, J. Sala, R. Masia, M. Pavesi, G. Sanz, V. Valle, L. Molina, L. Seres, R. Elosua, and for the RESCATE Investigators Mortality Differences Between Men and Women Following First Myocardial Infarction JAMA, October 28, 1998; 280(16): 1405 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Vaccarino, R. I. Horwitz, T. P. Meehan, M. K. Petrillo, M. J. Radford, and H. M. Krumholz Sex Differences in Mortality After Myocardial Infarction: Evidence for a Sex-Age Interaction Arch Intern Med, October 12, 1998; 158(18): 2054 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Gender and CHD Mortality Revisited: A Population View Journal Watch Women's Health, January 1, 1998; 1998(101): 16 - 16. [Full Text]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||