Clinical research study
Recent Trends in the Incidence, Treatment, and Outcomes of Patients with STEMI and NSTEMI

https://doi.org/10.1016/j.amjmed.2010.07.023Get rights and content

Abstract

Background

Despite the widespread use of electrocardiographic changes to characterize patients presenting with acute myocardial infarction, little is known about recent trends in the incidence rates, treatment, and outcomes of patients admitted for acute myocardial infarction further classified according to the presence of ST-segment elevation. The objectives of this population-based study were to examine recent trends in the incidence and death rates associated with the 2 major types of acute myocardial infarction in residents of a large central Massachusetts metropolitan area.

Methods

We reviewed the medical records of 5383 residents of the Worcester (MA) metropolitan area hospitalized for either ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment acute myocardial infarction (NSTEMI) between 1997 and 2005 at 11 greater Worcester medical centers.

Results

The incidence rates (per 100,000) of STEMI decreased appreciably (121 to 77), whereas the incidence rates of NSTEMI increased slightly (126 to 132) between 1997 and 2005. Although in-hospital and 30-day case-fatality rates remained stable in both groups, 1-year postdischarge death rates decreased between 1997 and 2005 for patients with STEMI and NSTEMI.

Conclusions

The results of this study demonstrate recent decreases in the magnitude of STEMI, slight increases in the incidence rates of NSTEMI, and decreases in long-term mortality in patients with STEMI and NSTEMI. Our findings suggest that acute myocardial infarction prevention and treatment efforts have resulted in favorable decreases in the frequency of STEMI and death rates from the major types of acute myocardial infarction.

Section snippets

Methods

The Worcester Heart Attack Study is an ongoing population-based investigation examining long-term trends in the incidence rates, in-hospital, and post-discharge case-fatality rates (CFRs) of greater Worcester (MA) (2000 census = 478,000) residents hospitalized with acute myocardial infarction at all metropolitan Worcester medical centers. In brief, the medical records of greater Worcester residents admitted to all 11 hospitals throughout central Massachusetts with a discharge diagnosis of acute

Characteristics of Study Patients

A total of 5383 greater Worcester residents were hospitalized with confirmed acute myocardial infarction during the 5 biennial study years (Table 1). Individuals hospitalized for STEMI were more likely to be younger, male, and were less likely to have a prior history of several comorbidities in comparison with patients with NSTEMI. Patients with STEMI were also more likely to undergo cardiac catheterization or PCI and to be treated with aspirin, beta-blockers, and either an

Trends in Hospitalization Rates

Hospitalization rates for acute myocardial infarction have remained largely stable or slightly increased over time in the US population.6, 16, 17 Our results provide relatively recent insights into these trends by suggesting that recent decreases in hospitalization for STEMI have been counter-balanced by slight increases in hospitalization for NSTEMI.

Improved coronary risk factor awareness and treatment practices may have contributed to the decreases in the incidence of STEMI observed in the

Conclusions

The incidence rates of STEMI decreased significantly between 1997 and 2005. Incidence rates of NSTEMI increased slightly during this period, likely as a result of high-sensitivity biomarker introduction. Encouraging trends were noted in the postdischarge death rates for both STEMI and NSTEMI at 1 year, suggesting that acute myocardial infarction treatment practices have likely improved the long-term outlook for all patients hospitalized with acute myocardial infarction. Increased attention

Acknowledgments

We wish to acknowledge all persons involved in the review of data for this project as well as to our collaborators at all greater Worcester hospitals.

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    Funding: National Institutes of Health (RO1 HL35434).

    Conflict of Interest: There are no conflicts of interest to report for any of the authors.

    Authorship: All authors had access to the data and had a role in writing this manuscript.

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