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. 2010 Feb 23;121(7):863-9.
doi: 10.1161/CIRCULATIONAHA.109.897249. Epub 2010 Feb 8.

Trends in incidence, severity, and outcome of hospitalized myocardial infarction

Véronique L Roger  1 , Susan A Weston, Yariv Gerber, Jill M Killian, Shannon M Dunlay, Allan S Jaffe, Malcolm R Bell, Jan Kors, Barbara P Yawn, Steven J Jacobsen
Affiliations

Trends in incidence, severity, and outcome of hospitalized myocardial infarction

Véronique L Roger et al. Circulation. .

Abstract

Background: In 2000, the definition of myocardial infarction (MI) changed to rely on troponin rather than creatine kinase (CK) and its MB fraction (CK-MB). The implications of this change on trends in MI incidence and outcome are not defined.

Methods and results: This was a community study of 2816 patients hospitalized with incident MI from 1987 to 2006 in Olmsted County, Minnesota, with prospective measurements of troponin and CK-MB from August 2000 forward. Outcomes were MI incidence, severity, and survival. After troponin was introduced, 278 (25%) of 1127 incident MIs met only troponin-based criteria. When cases meeting only troponin criteria were included, incidence did not change between 1987 and 2006. When restricted to cases defined by CK/CK-MB, the incidence of MI declined by 20%. The incidence of non-ST-segment elevation MI increased markedly by relying on troponin, whereas that of ST-segment elevation MI declined regardless of troponin. The age- and sex-adjusted hazard ratio of death within 30 days for an infarction occurring in 2006 (compared with 1987) was 0.44 (95% confidence interval, 0.30 to 0.64). Among 30-day survivors, survival did not improve, but causes of death shifted from cardiovascular to noncardiovascular (P=0.001). Trends in long-term survival among 30-day survivors were similar regardless of troponin.

Conclusions: Over the last 2 decades, a substantial change in the epidemiology of MI occurred that was only partially mediated by the introduction of troponin. Non-ST-segment elevation MIs now constitute the majority of MIs. Although the 30-day case fatality improved markedly, long-term survival did not change, and the cause of death shifted from cardiovascular to noncardiovascular.

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Conflict of interest statement

Disclosures: Allan S. Jaffe, MD consults for the following companies: Beckman, Siemens, Critical Diagnostics, Ortho Clinical Diagnostics, Singulex, Nanosphere, Novartis, Inverness Medical, GSK.

Figures

Figure 1
Figure 1
Trends in incidence of hospitalized MI from 1987 to 2006 in Olmsted County, Minnesota. Incidence rates are shown on a linear scale and are adjusted by the direct method to the age distribution of the total US population in 2000. They are reported per 100,000 and by sex. The dotted lines represent the incidence rates measured while including only cases meeting CK/CKMB-based criteria. The solid lines represent the incidence rates measured while also including cases meeting only troponin-based criteria.
Figure 2
Figure 2
Trends in incidence of hospitalized MI from 1987 to 2006 in Olmsted County, Minnesota by ST segment elevation status. Incidence rates are shown on a linear scale and are adjusted by the direct method to the age distribution of the total US population in 2000. They are reported per 100,000 and by sex. The gray lines represent the incidence rates measured while including only cases meeting CK/CKMB-based criteria. The black lines represent the incidence rates measured while also including cases meeting only troponin-based criteria.
Figure 3
Figure 3
Thirty-day case fatality rates for incident hospitalized MI overall and by age, sex and time period.
See this image and copyright information in PMC

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