Abstract 15807: The Changing Epidemiology of Myocardial Infarction in the Population, 1995-2012
Background: Contemporary data on the epidemiology of myocardial infarction (MI) in the population are limited and derived primarily from cohorts of hospitalized MI patients. We assessed temporal trends in incident and recurrent MI, with further partitioning of the rates into pre-hospital deaths and hospitalized events, in a geographically defined community.
Methods and Results: All MI events recorded among Olmsted County, Minnesota, residents aged ≥25 years from 1995-2012, including pre-hospital deaths, were classified into incident and recurrent. Standardized rates were calculated and temporal trends compared. Altogether, 5,258 MIs occurred including 1,448 (27.5%) recurrences; 430 (8.2%) pre-hospital deaths were recorded. Among hospitalized events, recurrent MI was associated with greater mortality risk than incident MI (age-, sex- and year-adjusted hazard ratio, 1.49; 95% confidence interval, 1.37-1.61). Although the overall rate of MI declined over time (average annual percent change, -3.3), the magnitude of the decline varied widely (Figure). Incident hospitalized MI rate fell 2.7%/y, compared with decreases of 1.5%/y in recurrent hospitalized MI, 14.1%/y in pre-hospital fatal incident MI, and 12.3% in pre-hospital fatal recurrent MI (all P for diverging trends<0.05). These trends resulted in an increasing proportion of recurrences among hospitalized MIs (25.3% in 1995-2000, 26.8% in 2001-2006, and 29.0% in 2007-2012, Ptrend=0.02).
Conclusions: Over the past 18 years, a heterogeneous decline in MI rates occurred in Olmsted County, with a transition from incident to recurrent events and a near elimination of pre-hospital MI deaths. Recurrent MI confers a worse prognosis, thereby stressing the need for secondary prevention strategies.
Author Disclosures: Y. Gerber: None. S.A. Weston: None. R. Jiang: None. V.L. Roger: None.
- © 2014 by American Heart Association, Inc.