25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study

Abstract

Objectives To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity.Design Nationwide population based cohort study using medical registries. Setting All hospitals in Denmark.Subjects 234 331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008. Main outcome measuresStandardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression.Results The standardised incidence rate per 100 000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days. ConclusionsThe rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.

Almanac 2013-stable coronary artery disease

“…A similar pattern was observed in young women with rates of decline of 5% and 38% during the same time periods. This is encouraging, particularly in the context of data from Denmark and the UK showing declining mortality and also a sharp fall in standardised incidence rates for acute myocardial infarction indicating that coronary prevention, as well as acute treatments, has contributed to recent mortality trends (4,5). Meanwhile an Australian study reminds us that myocardial infarction is but one of several manifestations of cardiovascular disease by reporting that decreasing incidence and recurrence rates for hospitalised CHD from 2000 to 2007 have also been seen for cerebrovascular and peripheral arterial disease (6).…”

Antecedent Hypertension and Myocardial Injury in Patients With Reperfused St-Elevation Myocardial Infarction

“…For instance, Thune et al found that antecedent HTN at the time of MI was strongly associated with an increased risk of future heart failure, stroke, cardiovascular death and a composite endpoint consisting of death, myocardial infarction, heart failure, stroke, or cardiac arrest in more than 14.000 patients included in the VALI-ANT trial (Valsartan in Myocardial Infarction Trial) [4]. Nevertheless, over the last years, reperfusion strategies and pharmacological interventions were significantly refined and consequently improved the outcome of patients presenting with acute MI [25]. These advances might have modified the relationship between HTN and the clinical course after STEMI [26].…”

Acute coronary syndrome – the present and future role of biomarkers1)

“…The incidence of ACS is declining in most developed countries [3,4]. Lifestyle adjustments in the general population, e.g., reduction in smoking and of serum cholesterol levels, have contributed to the reduction in incidence [5].…”