Temporal trends in clinical characteristics of patients without known cardiovascular disease with a first episode of myocardial infarction

Abstract

Background Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI. Methods In the American Heart Association's Get With The Guidelines–Coronary Artery Disease national registry, 100,884 patients without known cardiovascular disease presenting with acute MI from 408 hospitals were evaluated between 2002 and 2008. The time trends of the proportion of patients with cardiovascular risk factors (nonmodifiable: age >45 years for men or >55 years for women, male sex, modifiable: diabetes mellitus, hypertension, hyperlipidemia, tobacco use) were analyzed. Analyses were stratified by non–ST-segment elevation MI (NSTEMI) versus ST-segment elevation MI (STEMI). Results The proportion of patients with ≥3 of 6 traditional risk factors slightly decreased over time in the NSTEMI (69.5%-66.8%, P < .0001) and STEMI (68.9%-66.4%, P < .0001) cohorts. The proportion of patients with ≥2 of 4 modifiable risk factors increased from 52% to 59% and then declined to 52.1% (P < .0001) in the NSTEMI cohort but declined slightly in the STEMI cohort (50.9%-47.3%, P < .0001). After adjusting for age and gender, the time trend of proportion with diabetes mellitus, hypertension, and tobacco use declined in both cohorts. However, the proportion of patients with hyperlipidemia remained similar. Conclusions Although risk factor profiles in patients presenting with first MI have shown improvements over time, the changes are modest.

Diagnosis of takotsubo cardiomyopathy is increasing over time in patients presenting as ST-elevation myocardial infarction

“…However, this cannot be the entire explanation for the increased number of observed cases of takotsubo cardiomyopathy, because after correcting for age in the multivariate model there was still a relationship between later years and increase of takotsubo cardiomyopathy in our study. Another explanation for this increase may be changed risk profiles of admitted STEMI patients over the years, which was also observed in other studies [18, 19]. These changes in risk factors only partly explain the difference in observed frequency of takotsubo cardiomyopathy in our study, since after multivariable analyses takotsubo cardiomyopathy was still more prevalent in recent years.…”

Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec

“…A recent study revealed modest improvements over time in risk factor profiles of patients without known cardiovascular disease who presented with a first myocardial infarction. 14 Because ventricular arrhythmias are life-threatening complications of acute myocardial infarction that are relatively common among people with no prior history of CHD, 15 documenting the incidence of CHD mortality without prior CHD diagnosis would be useful. Chugh et al 16 (p. 219) went further and mentioned that there exists ''a critical need to learn more about patients who suffer SCD…”

The use of prehospital variables to predict acute coronary artery disease in failed resuscitation attempts for out-of-hospital cardiac arrest

“…29 We report a nearly identical proportion of acutely thrombosed coronary arteries (77%) among patients with an initial shockable rhythm nearly 30 years later amongst a larger cohort; moreover, our analysis includes both witnessed and unwitnessed arrests in an era in which VF as the initial rhythm has declined in prevalence, [30][31][32][33][34][35] concomitant with a decline in overall mortality due to ischemic heart disease. 1,36 Cases that did not undergo autopsy had significantly higher rates of known risk factors for CAD than those who underwent autopsy in our cohort, which suggests that pathologically examined cases may have a lower CAD burden than their unexamined counterparts. Despite the potential for under-representation of CAD, a shockable initial rhythm was still highly predictive of acute ischemic heart disease and should be the working diagnosis until proven otherwise.…”