BACKGROUND: Declining mortality rates of coronary heart disease in the United States could be attributable to declining incidence, declining severity, and/or improvements in treatment. METHODS: We examined trends in severity of patients hospitalized for myocardial infarction to characterize its contribution to this decline by using data from the Atherosclerosis Risk in Communities (ARIC) study. RESULTS: No significant change in the proportion having systolic blood pressure <100 mm Hg or an abnormal pulse at presentation was noted. The proportion with ST-segment elevation on the initial electrocardiogram increased 10% per year (P <.001), and the proportion with a diagnostic or evolving diagnostic electrocardiogram abnormality increased 4% per year (P <.01); the proportion that had a new Q-wave infarction develop remained unchanged. The mean peak creatine kinase level decreased 5% per year (P <.001), the proportion with abnormal enzyme levels decreased 10% per year (P <.001), and the proportion that met criteria for definite myocardial infarction decreased 4% per year (P <.05). The proportion that had cardiogenic shock decreased 10.9% per year (P <. 01), but the proportion that had an acute episode of congestive heart failure was stable. CONCLUSIONS: With stable hemodynamic indicators, worsening electrocardiographic indicators, and improving enzymatic indicators, these results provide mixed support for decreases in the severity of myocardial infarction.
BACKGROUND: Declining mortality rates of coronary heart disease in the United States could be attributable to declining incidence, declining severity, and/or improvements in treatment. METHODS: We examined trends in severity of patients hospitalized for myocardial infarction to characterize its contribution to this decline by using data from the Atherosclerosis Risk in Communities (ARIC) study. RESULTS: No significant change in the proportion having systolic blood pressure <100 mm Hg or an abnormal pulse at presentation was noted. The proportion with ST-segment elevation on the initial electrocardiogram increased 10% per year (P <.001), and the proportion with a diagnostic or evolving diagnostic electrocardiogram abnormality increased 4% per year (P <.01); the proportion that had a new Q-wave infarction develop remained unchanged. The mean peak creatine kinase level decreased 5% per year (P <.001), the proportion with abnormal enzyme levels decreased 10% per year (P <.001), and the proportion that met criteria for definite myocardial infarction decreased 4% per year (P <.05). The proportion that had cardiogenic shock decreased 10.9% per year (P <. 01), but the proportion that had an acute episode of congestive heart failure was stable. CONCLUSIONS: With stable hemodynamic indicators, worsening electrocardiographic indicators, and improving enzymatic indicators, these results provide mixed support for decreases in the severity of myocardial infarction.
Authors: Véronique L 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 Journal: Circulation Date: 2010-02-08 Impact factor: 29.690
Authors: B Gwen Windham; Kimystian L Harrison; Seth T Lirette; Pamela L Lutsey; Lisa A Pompeii; Kelley Pettee Gabriel; Silvia Koton; Lyn M Steffen; Michael E Griswold; Thomas H Mosley Journal: J Am Geriatr Soc Date: 2017-02-06 Impact factor: 5.562
Authors: David Q Rich; Howard M Kipen; Junfeng Zhang; Leena Kamat; Alan C Wilson; John B Kostis Journal: Environ Health Perspect Date: 2010-04-30 Impact factor: 9.031
Authors: S Nielsen; L Björck; J Berg; K W Giang; T Zverkova Sandström; K Falk; S Määttä; A Rosengren Journal: BMJ Open Date: 2014-05-02 Impact factor: 2.692