Abstract 806: Case Fatality Following Acute Myocardial Infarction: Improvements in Men Not Observed in Women
Background: Review of death certificates indicates a steady decline in cardiovascular mortality over the past half century. Unfortunately, there are few population-based studies that have surveyed acute myocardial infarction (AMI) patients and compared their mortality by gender over time.
Hypothesis: We hypothesized a decline in AMI case fatality over the past two decades.
Methods: The Minnesota Heart Survey is a population-based study of AMI patients, age 30–74 living in the Minneapolis-St. Paul metropolitan area and discharged from all but one small hospital in that area with a discharge diagnosis of acute coronary syndrome (ICD-9 410 and 411). The diagnosis of AMI was validated using the AHA algorithm. Mortality was identified by linking cases to death certificates. Age-adjusted Cox proportional hazard models were utilized to construct 3-year mortality curves from four consecutive survey periods: 1985 (n=431), 1990 (n=2027), 1995 (n=1496), and 2001 (n=978).
Results: Three-year mortality for AMI patients successfully declined for men over the past 20 years. Compared to men with AMI in 1985, men with AMI in 2001 experienced more than a 50% reduction in 3-year mortality. In contrast, mortality among women declined in a parallel fashion to men from 1985 to 1995, but did not change significantly change between the 1995 and 2001 surveys. In each survey, mortality among women was higher than observed among men.
Conclusions: Three-year mortality for AMI continues to decline for men. The failure to observe a similar decline among women after 10 years of progress should serve to focus attention on treatment of women with cardiovascular disease.