Abstract 12235: The Incidence of Acute Myocardial Infarction is Decreasing but Out-of-Hospital Cardiac Arrest of Cardiac Origin is Increasing in the Completely Registered Data Out of 1,800,000 Prefectural Inhabitants in an Era of Aging Population
Background: A great number of registries on acute myocardial infarction (AMI) demonstrated that there was a steady trend of increasing incidence for AMI. However, a small number of AMI patients in the limited areas and hospitals where coronary intervention is aggressively performed are merely included. Moreover, patients with cardiac arrest probably due to AMI who were not transferred to a hospital are rarely counted. Kumamoto Acute Coronary Event (KACE) Study has been conducted since 2004 to explore the accurate trends for AMI and cardiac death in an era of an aging population.
Methods and Results: Kumamoto prefecture is located in southwestern Japan and has a stable population over the last 10 years (1,852,135 in 2004 and 1,805,000 in 2011). A total of 8,131 AMI patients in 2004-2011 and 6,064 patients with out-of-hospital cardiac arrest (OHCA) of presumed cardiac origin in 2005-2011 in Kumamoto prefecture were entirely registered. The age-adjusted incidence (/100,000 persons/year) of AMI decreased from 32.8 in 2004 to 24.5 in 2011 (P=0.005). However, the proportion of AMI patients >80 years in 2010-2011 were higher than those in 2004-2005 (30 vs 26%, P=0.010). Moreover, the rate of non-cardiac death (e.g. sepsis, multiple organ failure, pneumonia, adult respiratory distress syndrome) evidently increased from 10% in 2004-2005 to 20% in 2010-2011 (P=0.049). Whereas, overall age-adjusted incidence of OHCA gradually increased from 18.4 in 2005 to 24.6 in 2011 (P=0.006). Especially, the incidence of OHCA patients >85 years in 2011 was 1.8 times as much as those in 2005 (Figure).
Conclusions: Decreasing incidence of AMI is recently equal to increasing incidence of OHCA of cardiac origin. Non-cardiac death due to complications accompanied by medical treatments is highlighted rather than cardiac death in senior AMI patients. Urgent measures against cardiovascular emergency care indispensable to patients of advanced age should be taken in an era of an aging population in Japan.
- © 2013 by American Heart Association, Inc.