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

Veronique Lee Roger, 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

Research output: Contribution to journalArticle

201 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)863-869
Number of pages7
JournalCirculation
Volume121
Issue number7
DOIs
StatePublished - Feb 2010

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Troponin
Myocardial Infarction
Incidence
MB Form Creatine Kinase
Survival
Creatine Kinase
Survivors
Cause of Death
Infarction
Epidemiology
Confidence Intervals

Keywords

  • Biomarkers
  • Incidence
  • Mortality
  • Myocardial infarction

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Trends in incidence, severity, and outcome of hospitalized myocardial infarction. / Roger, Veronique Lee; Weston, Susan A.; Gerber, Yariv; Killian, Jill M.; Dunlay, Shannon M; Jaffe, Allan S; Bell, Malcolm R.; Kors, Jan; Yawn, Barbara P.; Jacobsen, Steven J.

In: Circulation, Vol. 121, No. 7, 02.2010, p. 863-869.

Research output: Contribution to journalArticle

Roger, VL, Weston, SA, Gerber, Y, Killian, JM, Dunlay, SM, Jaffe, AS, Bell, MR, Kors, J, Yawn, BP & Jacobsen, SJ 2010, 'Trends in incidence, severity, and outcome of hospitalized myocardial infarction', Circulation, vol. 121, no. 7, pp. 863-869. https://doi.org/10.1161/CIRCULATIONAHA.109.897249
Roger, Veronique Lee ; Weston, Susan A. ; Gerber, Yariv ; Killian, Jill M. ; Dunlay, Shannon M ; Jaffe, Allan S ; Bell, Malcolm R. ; Kors, Jan ; Yawn, Barbara P. ; Jacobsen, Steven J. / Trends in incidence, severity, and outcome of hospitalized myocardial infarction. In: Circulation. 2010 ; Vol. 121, No. 7. pp. 863-869.
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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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T1 - Trends in incidence, severity, and outcome of hospitalized myocardial infarction

AU - Roger, Veronique Lee

AU - Weston, Susan A.

AU - Gerber, Yariv

AU - Killian, Jill M.

AU - Dunlay, Shannon M

AU - Jaffe, Allan S

AU - Bell, Malcolm R.

AU - Kors, Jan

AU - Yawn, Barbara P.

AU - Jacobsen, Steven J.

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Y1 - 2010/2

N2 - 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.

AB - 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.

KW - Biomarkers

KW - Incidence

KW - Mortality

KW - Myocardial infarction

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