ST elevation myocardial infarction epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Yuri B. Pride, M.D. [2] ; Cafer Zorkun, M.D., Ph.D. [3]
Overview
Myocardial infarction is a common presentation of ischemic heart disease. The World Heart Organization (WHO) estimated in 2002 that, 12.6 percent of deaths worldwide were from ischemic heart disease.
Ischemic heart disease is the leading cause of death in developed countries, but third to AIDS and lower respiratory infections in developing countries.[1]
Epidemiology
Over 9 million patients in the United States alone have angina. An estimated 80,700,000 American adults (one in three) have one or more types of cardiovascular disease (CVD), of whom 38,200,000 are estimated to be age 60 or older. Except as noted, the estimates were extrapolated to the U.S. population in 2005 from NHANES 1999–2004. (Total CVD includes diseases in the bullet points below except for congenital heart disease). Due to overlap, it is not possible to add these conditions to arrive at a total. [2] [3][4]
- Hypertension: 73,000,000
- Coronary heart disease: 16,000,000
- Myocardial infarction: 8,100,000
- Angina pectoris: 9,100,000
- Heart failure: 5,300,000
- Stroke: 5,800,000
- Congenital heart disease: 650,000 – 1,300,000
This means that roughly every 65 seconds, an American dies of a coronary event.
Prevalence
The following prevalence estimates are for people age 18 and older from NCHS/NHIS, 2005: [5]
- Among whites only, 12.0% have heart disease, 6.6% have CHD, 21.0% have hypertension and 2.3% have had a stroke.
- Among blacks, 10.2% have heart disease, 6.2% have CHD, 31.2% have hypertension and 3.4% have had a stroke.
- Among Hispanics or Latinos, 8.3% have heart disease, 5.9% have CHD, 20.3% have hypertension and 2.2% have had a stroke.
- Among Asians, 6.7% have heart disease, 3.8% have CHD, 19.4% have hypertension and 2.0% have had a stroke.
- Among Native Hawaiians or other Pacific Islanders, 22.4% have hypertension (other prevalence estimates considered unreliable).
Although it is difficult to ascertain the true incidence of ST elevation myocardial infarction (STEMI), according to the ACC/AHA guidelines, a conservative estimate is that approximately 500,000 patients suffer STEMI each year [6]. The incidence of STEMI has decreased over time. In an observational study of 5,832 metropolitan patients spanning from 1975 to 1997, the incidence of STEMI decreased from 171/100,000 to 101/100,000 [7]
Risk factors for STEMI mirror those for coronary artery disease (CAD) and include diabetes mellitus, cerebrovascular disease manifested by stroke or transient ischemic attack, peripheral arterial disease, aortic atherosclerosis and aneurysm, age (male ≥45 years old, female ≥55 years old), family history of premature CAD (MI or sudden death before age 55 in a first-degree male relative or before age 65 in a first-degree female relative), tobacco abuse, hypertension, hyperlipidemia and low high-density lipoprotein (HDL) [8]
The mortality among patients who suffer STEMI has progressively declined in recent years. From 1975 to 1997, one observational study reported that the in-hospital mortality decreased from 24% to 14% [7]. In the Global Registry of Acute Coronary Events (GRACE), a multinational cohort study that includes 16,814 patients with STEMI were enrolled and followed up in 113 hospitals in 14 countries between 1999 and 2006, in-hospital mortality declined from 8.4% in 1999 to 4.6% in 2005 [9].
The reason for this decline in mortality is likely multifactorial and includes, but is certainly not limited to, decline in symptom onset-to-presentation time, more widespread use of primary PCI [10], improvements in time to reperfusion (door-to-needle and door-to-balloon times) [11][12] and improved medical therapy, including increases in the use of evidence-based therapies such as aspirin [13], beta blockers[14] [15], clopidogrel [16], statins [17] and angiotension converting enzyme inhibitors or angiotensin receptor blockers [18].
Related Chapters
Sources
- The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [19]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [20]
References
- ↑ "Cause of Death - UC Atlas of Global Inequality". Center for Global, International and Regional Studies (CGIRS) at the University of California Santa Cruz. Unknown parameter
|accessyear=ignored (|access-date=suggested) (help); Unknown parameter|accessmonthday=ignored (help) - ↑ 2008 Heart Disease and Stroke Statistics
- ↑ Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". Circulation. 116 (7): e148–304. doi:10.1161/CIRCULATIONAHA.107.181940. PMID 17679616. Unknown parameter
|month=ignored (help) - ↑ Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". J. Am. Coll. Cardiol. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Unknown parameter
|month=ignored (help) - ↑ Vital Health Stat 10.2006 [232]: 1–153
- ↑ Antman EM, Anbe DT, Armstrong PW; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction)". J. Am. Coll. Cardiol. 44 (3): E1–E211. doi:10.1016/j.jacc.2004.07.014. PMID 15358047. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Furman MI, Dauerman HL, Goldberg RJ, Yarzebski J, Lessard D, Gore JM (2001). "Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective". J. Am. Coll. Cardiol. 37 (6): 1571–80. PMID 11345367. Unknown parameter
|month=ignored (help) - ↑ "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)". JAMA. 285 (19): 2486–97. 2001. PMID 11368702. Unknown parameter
|month=ignored (help) - ↑ Fox KA, Steg PG, Eagle KA; et al. (2007). "Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006". JAMA. 297 (17): 1892–900. doi:10.1001/jama.297.17.1892. PMID 17473299. Unknown parameter
|month=ignored (help) - ↑ Rogers WJ, Canto JG, Lambrew CT; et al. (2000). "Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3". J. Am. Coll. Cardiol. 36 (7): 2056–63. PMID 11127441. Unknown parameter
|month=ignored (help) - ↑ McNamara RL, Wang Y, Herrin J; et al. (2006). "Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction". J. Am. Coll. Cardiol. 47 (11): 2180–6. doi:10.1016/j.jacc.2005.12.072. PMID 16750682. Unknown parameter
|month=ignored (help) - ↑ Nallamothu B, Fox KA, Kennelly BM; et al. (2007). "Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events". Heart. 93 (12): 1552–5. doi:10.1136/hrt.2006.112847. PMID 17591643. Unknown parameter
|month=ignored (help) - ↑ "Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group". Lancet. 2 (8607): 349–60. 1988. PMID 2899772. Unknown parameter
|month=ignored (help) - ↑ "Metoprolol in acute myocardial infarction. Mortality. The MIAMI Trial Research Group". Am. J. Cardiol. 56 (14): 15G–22G. 1985. PMID 3904389. Unknown parameter
|month=ignored (help) - ↑ "Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group". Lancet. 2 (8498): 57–66. 1986. PMID 2873379. Unknown parameter
|month=ignored (help) - ↑ Sabatine MS, Cannon CP, Gibson CM; et al. (2005). "Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation". N. Engl. J. Med. 352 (12): 1179–89. doi:10.1056/NEJMoa050522. PMID 15758000. Unknown parameter
|month=ignored (help) - ↑ Cannon CP, Braunwald E, McCabe CH; et al. (2004). "Intensive versus moderate lipid lowering with statins after acute coronary syndromes". N. Engl. J. Med. 350 (15): 1495–504. doi:10.1056/NEJMoa040583. PMID 15007110. Unknown parameter
|month=ignored (help) - ↑ Latini R, Maggioni AP, Flather M, Sleight P, Tognoni G (1995). "ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials". Circulation. 92 (10): 3132–7. PMID 7586285. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter
|month=ignored (help)
External links
- Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study, from the United States National Heart, Lung and Blood Institute
- Heart Attack - overview of resources from MedlinePlus.
- Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada
- Regional PCI for STEMI Resource Center - Evidence based online resource center for the development of regional PCI networks for acute STEMI
- STEMI Systems - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
- American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.
- American Heart Association's Heart Attack web site - Information and resources for preventing, recognizing and treating heart attack.