Abstract 024: Trends in Anatomical Location and Case Fatality of Myocardial Infarction in Four US Communities, 1987–2008: The Atherosclerosis Risk in Communities (ARIC) Study
INTRODUCTION: Although the incidence of and mortality following ST-segment elevation MI (STEMI) is decreasing, time-trends in STEMI infarct location and associated prognosis have not been examined in a population-based community study.
METHODS: We determined 22-year trends in age-adjusted, gender-specific incident hospitalized STEMI and 28-day case fatality among 35–74 year old residents of four ARIC surveillance study communities. STEMI location was assessed by 12-lead electrocardiograms (ECG) from hospital records and was coded as anterior (V2-V5), inferior (II, III, AVF), lateral (I, AVL, V6 alone or with V2-V5) or multiple (2 or more regions) infarct locations using Minnesota coding. Case fatalities were confirmed with linkage to the National Death Index.
RESULTS: From 1987 to 2008, there were an estimated 6,108 (fatal or non-fatal) hospitalized STEMIs, with an average annual decrease of −4.0% (95% CI, −4.7, −3.3) in men and −3.1% (95% CI −4.1, −2.1) in women. By infarct location, 37.2% of STEMIs were inferior; 32.8% anterior; 16.8% multiple territories; and 13.2% lateral. Annually, inferior STEMI decreased by −1.5% (95% CI −2.4, −0.6) while STEMI in multiple infarct regions increased by 2.9% (95% CI 1.9, 4.3), Figure. The 28-day case fatality for anterior, inferior and lateral STEMI decreased from 10.9% (95% CI 7.9, 13.9) to 5.1% (95% CI 3.0, 7.2), P < 0.01; from 6.1% (95% CI 4.5, 7.6) to 3.5% (95% CI 2.0, 5.0), P = 0.03; and from 14.8% (95% CI 8.6, 21.1) to 6.3% (95% CI 3.0, 9.6), P = 0.01, respectively. In contrast, no significant change in 28-day case fatality for STEMI in multiple infarct regions was observed.
CONCLUSION: Between 1987 and 2008, significant heterogeneity by infarct location was observed for incident STEMI and in 28-day mortality after STEMI. In contrast to STEMI in other infarct locations, the proportion of STEMI involving multiple infarct territories increased over 22 years of surveillance, without improvement in 28-day mortality. These findings may have implications for STEMI surveillance and management.
- © 2012 by American Heart Association, Inc.