Temporal Trends in Event Rates After Q-Wave Myocardial Infarction

Abstract

Background-Short-term (Ͻ30 day) mortality after Q-wave myocardial infarction (MI) has declined over the decades, but it is unclear if rates of long-term sequelae after Q-wave MI have improved. Methods and Results-In 546 Framingham Heart Study subjects (388 men with a mean age of 60 years; 158 women with a mean age of 69 years) with an initial recognized Q-wave MI from 1950 through 1989, we investigated time trends in risk for coronary heart disease (CHD) death (nϭ199), all-cause mortality (nϭ287), reinfarction (nϭ108), and congestive heart failure (CHF; nϭ121). With 1950 through 1969 as the reference period, hazards ratios (HRs) for these outcomes were determined for the 1970s and 1980s. Trend analyses across the 3 time periods were performed for each outcome.

Temporal Trends in Coronary Heart Disease Mortality and Sudden Cardiac Death From 1950 to 1999

“…1 Despite substantial declines, coronary heart disease (CHD) still accounts for nearly 700 000 deaths per year in the United States, 1 and sudden cardiac death (SCD) accounts for almost half of all CHD deaths, 2 constituting the largest component of CHD mortality. SCD is often the first and only manifestation of CHD, 3 highlighting the importance of primary prevention efforts.Whereas marked reductions have been documented in CHD mortality [4][5][6][7][8][9][10][11][6][7][8][12][13][14] most of the data describing trends in CHD mortality 4,7,8,10,11 and SCD 7,8,12,13 are based on relatively short-term follow-up, and classification of death is often made with death certificates. Lack of uniformity in death certificate designation of cause of death and changes in International Classification of Disease coding 15,16 limit the accuracy of estimates of longterm trends in CHD death and SCD.…”

Pharmacoeconomic Analysis of Clopidogrel in Secondary Prevention of Coronary Artery Disease

“…21 Based on event probabilities derived from the CURE database, the Framingham study, and the Spanish National Statistics, 2,22,23 Markov models were constructed assuming a payer' s perspective, using a base case of a 64-year-old patient on lifetime treatment. All costs were reported in 1999 euros (with 1 euro equaling slightly more than US $1 throughout 1999).…”

“…The availability of numerous large, randomized, controlled studies of clopidogrel efficacy allows pharmacoeconomic evaluations to be performed in different patient populations, using the data from health care resources consumed (e.g., number of hospitalizations, amount of outpatient care consumed, and medication cost). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] This article reviews previously published pharmacoeconomic analyses on the use of clopidogrel in patients with known CAD. These analyses include the use of clopidogrel for secondary prevention of CV events in patients with ACS and in those undergoing PCI.…”

Stem Cell Therapy for Heart Disease

“…1 AMI patients who previously might not have survived without percutaneous coronary intervention (PCI) are now living longer, 1 but with considerable left ventricular dysfunction. 3,4 Heart failure (HF) subsequently ensues, affecting 5.7 million Americans. 1,2,4,5 Despite advanced therapies, this is expected to increase to 9.6 million by 2030.…”

“…3,4 Heart failure (HF) subsequently ensues, affecting 5.7 million Americans. 1,2,4,5 Despite advanced therapies, this is expected to increase to 9.6 million by 2030. 1 Left ventricular dysfunction ultimately affects contractility, worsening HF and increasing mortality.…”