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Rincón LM, Subirana I, Pérez del Villar C, Sánchez PL, Zamorano JL, Marrugat J, Elosua R. Predictive capacity of a genetic risk score for coronary artery disease in assessing recurrences and cardiovascular mortality among patients with myocardial infarction. Front Cardiovasc Med 2023; 10:1254066. [PMID: 37781316 PMCID: PMC10537937 DOI: 10.3389/fcvm.2023.1254066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Aim This study aimed to evaluate the capacity of a genetic risk score (GRS) for coronary artery disease (CAD) independent of classical cardiovascular risk factors to assess the risk of recurrence in patients with first myocardial infarction. The secondary aim was to determine the predictive value of this GRS. Methods We performed a meta-analysis of individual data from three studies, namely, a prospective study including 75 patients aged <55 years, a prospective study including 184 patients with a mean age of 60.5 years, and a case-control study (77 cases and 160 controls) nested in a cohort of patients with first myocardial infarction. A GRS including 12 CAD genetic variants independent of classical cardiovascular risk factors was developed. The outcome was a composite of cardiovascular mortality and recurrent acute coronary syndrome. Results The GRS was associated with a higher risk of recurrence [hazard ratio = 1.24; 95% confidence interval (CI): 1.04-1.47]. The inclusion of the GRS in the clinical model did not increase the model's discriminative capacity (change in C-statistic/area under the curve: 0.009; 95% CI: -0.007 to 0.025) but improved its reclassification (continuous net reclassification index: 0.29; 95% CI: 0.08-0.51). Conclusion The GRS for CAD, independent of classical cardiovascular risk factors, was associated with a higher risk of recurrence in patients with first myocardial infarction. The predictive capacity of this GRS identified a subgroup of high-risk patients who could benefit from intensive preventive strategies.
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Affiliation(s)
- Luis Miguel Rincón
- Cardiology Department, Hospital Universitario de Salamanca–IBSAL, Universidad de Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Candelas Pérez del Villar
- Cardiology Department, Hospital Universitario de Salamanca–IBSAL, Universidad de Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pedro L. Sánchez
- Cardiology Department, Hospital Universitario de Salamanca–IBSAL, Universidad de Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Luis Zamorano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
- Cardiology Department, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Jaume Marrugat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Elosua
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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García-García C, Oliveras T, Serra J, Vila J, Rueda F, Cediel G, Labata C, Ferrer M, Carrillo X, Dégano IR, De Diego O, El Ouaddi N, Montero S, Mauri J, Elosua R, Lupón J, Bayes-Genis A. Trends in Short- and Long-Term ST-Segment-Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean Population-Based ST-Segment-Elevation Myocardial Infarction Registry. J Am Heart Assoc 2020; 9:e017159. [PMID: 33054490 PMCID: PMC7763375 DOI: 10.1161/jaha.120.017159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Coronary artery disease remains a major cause of death despite better outcomes of ST-segment-elevation myocardial infarction (STEMI). We aimed to analyze data from the Ruti-STEMI registry of in-hospital, 28-day, and 1-year events in patients with STEMI over the past 3 decades in Catalonia, Spain, to assess trends in STEMI prognosis. Methods and Results Between February 1989 and December 2017, a total of 7589 patients with STEMI were admitted consecutively. Patients were grouped into 5 periods: 1989 to 1994 (period 1), 1995 to 1999 (period 2), 2000 to 2004 (period 3), 2005 to 2009 (period 4), and 2010 to 2017 (period 5). We used Cox regression to compare 28-day and 1-year STEMI mortality and in-hospital complication trends across these periods. Mean patient age was 61.6±12.6 years, and 79.3% were men. The 28-day all-cause mortality declined from period 1 to period 5 (10.4% versus 6.0%; P<0.001), with a 40% reduction after multivariable adjustment (hazard ratio [HR], 0.6; 95% CI, 0.46-0.80; P<0.001). One-year all-cause mortality declined from period 1 to period 5 (11.7% versus 9.0%; P=0.001), with a 24% reduction after multivariable adjustment (HR, 0.76; 95% CI, 0.60-0.98; P=0.036). A significant temporal reduction was observed for in-hospital complications including postinfarct angina (-78%), ventricular tachycardia (-57%), right ventricular dysfunction (-48%), atrioventricular block (-45%), pericarditis (-63%), and free wall rupture (-53%). Primary ventricular fibrillation showed no significant downslope trend. Conclusions In-hospital STEMI complications and 28-day and 1-year mortality rates have dropped markedly in the past 30 years. Reducing ischemia-driven primary ventricular fibrillation remains a major challenge.
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Affiliation(s)
- Cosme García-García
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Teresa Oliveras
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Jordi Serra
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Joan Vila
- Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Ferran Rueda
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - German Cediel
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Carlos Labata
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Marc Ferrer
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Xavier Carrillo
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Irene R Dégano
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Oriol De Diego
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Nabil El Ouaddi
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Santiago Montero
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Josepa Mauri
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,Catalan Health Service Generalitat de Catalunya Barcelona Spain
| | - Roberto Elosua
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Josep Lupón
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
| | - Antoni Bayes-Genis
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
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3
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Mortality following first-time hospitalization with acute myocardial infarction in Norway, 2001-2014: Time trends, underlying causes and place of death. Int J Cardiol 2019; 294:6-12. [PMID: 31387821 DOI: 10.1016/j.ijcard.2019.07.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trends on cause-specific mortality following acute myocardial infarction (AMI) are poorly described and no studies have analyzed where do AMI patients die. We analyzed trends in 28-day and one-year mortality following an incident AMI with focus on changes over time in the underlying cause and place of death. METHODS We identified in the 'Cardiovascular Disease in Norway' Project all patients 25+ years, hospitalized with an incident AMI in Norway, 2001-2014. Information on date, underlying cause and place of death was obtained from the Cause of Death Registry. RESULTS Of 144,473 patients included in the study, 11.4% died within first 28 days. The adjusted 28-day mortality declined by 5.2% per year (ptrend < 0.001). Of 118,881 patients surviving first 28 days, 10.1% died within one year. The adjusted one-year CVD mortality declined by 6.2% per year (ptrend < 0.001) while non-CVD mortality increased by 1.4% per year (ptrend < 0.001), mainly influenced by increased risk of dying from neoplasms. We observed a shift over time in the underlying cause of death toward more non-CVD deaths, and in the place of death toward more deaths occurring in nursing homes. CONCLUSIONS We observed a decline in 28-day mortality following an incident AMI hospitalization. One-year CVD mortality declined while one-year risk of dying from non-CVD conditions increased. The resulting shift toward more non-CVD deaths and deaths occurring outside a hospital need to be considered when formulating priorities in treating and preventing adverse events among AMI survivors.
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4
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Iniciativas para conseguir una atención excelente en el síndrome coronario agudo. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2017.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Lozano Í, Rondán J, Vegas JM, Segovia E. Initiatives to Achieve Excellence in the Care of Acute Coronary Syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:1026-1027. [PMID: 28774631 DOI: 10.1016/j.rec.2017.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Íñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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6
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Sulo E, Vollset SE, Nygård O, Sulo G, Igland J, Egeland GM, Ebbing M, Tell GS. Trends in 28-day and 1-year mortality rates in patients hospitalized for a first acute myocardial infarction in Norway during 2001-2009: a "Cardiovascular disease in Norway" (CVDNOR) project. J Intern Med 2015; 277:353-361. [PMID: 24815825 DOI: 10.1111/joim.12266] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the trends in 28-day and 1-year mortality rates in patients hospitalized for a first acute myocardial infarction (AMI) in Norway during the period 2001-2009. Potential age group and gender differences in these trends were also examined. DESIGN, SUBJECTS AND SETTING In this retrospective nationwide cohort study, patients hospitalized for a first AMI between 2001 and 2009 were identified in the Cardiovascular Disease in Norway 1994-2009 (CVDNOR) project and followed for 1 year. MAIN OUTCOME MEASURES Trends in 28-day and 1-year mortality [both all-cause and cardiovascular disease (CVD) mortality] were investigated. RESULTS A total of 115,608 patients (60.6% men) were hospitalized for a first AMI during the study period. Mortality at 28 days was reduced annually by 3.8% overall and by 6.7%, 4.1% and 2.6% in patients aged 25-64, 65-84 and ≥85 years, respectively (all Ptrend < 0.001). In addition, 1-year all-cause mortality was reduced annually by 2.0% overall (Ptrend < 0.001) and by 3.7% (Ptrend = 0.02), 2.5% (Ptrend < 0.001) and 1.1% (Ptrend < 0.001) in patients aged 25-64, 65-84 and ≥85 years, respectively. Furthermore, 1-year CVD mortality was reduced overall by 6.2% annually; a reduction was observed in all age groups. Finally, 1-year non-CVD mortality increased annually overall by 3.9% due to an increase in patients aged ≥65 years. CONCLUSION Mortaity at 28 days after the first AMI declinedin Norway between 2001 and 2009 in both men and women and in all age groups. All-cause mortality at 1 year also declined both in men and women due to decreases in CVD mortality rates, whilst non-CVD mortality rates increased amongst patients ≥65 years of age.
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Affiliation(s)
- E Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - S E Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway
| | - O Nygård
- Section for Cardiology, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - G Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - G M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - M Ebbing
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - G S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
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7
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Freisinger E, Fuerstenberg T, Malyar NM, Wellmann J, Keil U, Breithardt G, Reinecke H. German nationwide data on current trends and management of acute myocardial infarction: discrepancies between trials and real-life. Eur Heart J 2014; 35:979-88. [DOI: 10.1093/eurheartj/ehu043] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Abstract
This overview provides a Europe-wide update on the current burden of cardiovascular disease, and specifically of coronary heart disease and stroke. Cardiovascular disease continues to cause a large proportion of deaths and disability in Europe, and places a substantial burden on the health care systems and economies of Europe. The overall picture, and the distribution of the burden, continues to evolve in a developing Europe. There have been major improvements in recent years on many measures of cardiovascular disease; however, these improvements have not been universal, and substantial inequalities persist.
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Affiliation(s)
- Melanie Nichols
- British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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9
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Dégano IR, Elosua R, Marrugat J. Epidemiología del síndrome coronario agudo en España: estimación del número de casos y la tendencia de 2005 a 2049. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.01.019] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Dégano IR, Elosua R, Marrugat J. Epidemiology of acute coronary syndromes in Spain: estimation of the number of cases and trends from 2005 to 2049. ACTA ACUST UNITED AC 2013; 66:472-81. [PMID: 24776050 DOI: 10.1016/j.rec.2013.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Acute coronary syndromes are a leading cause of mortality, morbidity, and health care cost in Spain. The aims of this report are to estimate the number of acute coronary syndromes cases in the Spanish population in 2013 and 2021, and the trend from 2005 to 2049. We estimated the number of acute coronary syndromes cases by sex and Spanish autonomous community using data from the most updated population and hospital registries. We present the estimated number of cases with an exact 95% confidence interval, assuming that the number of cases followed a Poisson distribution. There will be 115,752 acute coronary syndromes cases in Spain in 2013 (95% confidence interval, 114,822-116,687). Within 28 days, 39,086 of these patients will die and 85,326 will be hospitalized. Non-ST segment elevation acute coronary syndromes (56%) and acute myocardial infarction (81%) will be the most common admission and discharge diagnoses, respectively. We estimate approximately 109,772 acute coronary syndromes cases in 2021 (95% confidence interval, 108,868-110,635). The trend of acute coronary syndromes cases from 2005 to 2049 will stabilize in the population aged 25 to 74 years, but increase in those older than 74 years. Due to population aging, the number of acute coronary syndrome cases will increase overall until 2049, it may stabilize in the population aged <75 years. The acute coronary syndromes case-fatality has decreased in hospitalized patients but the proportion of sudden deaths remains unchanged.
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Affiliation(s)
- Irene R Dégano
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain
| | - Roberto Elosua
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain.
| | - Jaume Marrugat
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain
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11
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Koopman C, Bots ML, van Oeffelen AAM, van Dis I, Verschuren WMM, Engelfriet PM, Capewell S, Vaartjes I. Population trends and inequalities in incidence and short-term outcome of acute myocardial infarction between 1998 and 2007. Int J Cardiol 2012; 168:993-8. [PMID: 23168007 DOI: 10.1016/j.ijcard.2012.10.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/24/2012] [Accepted: 10/28/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We studied time trends in acute myocardial infarction (AMI) incidence, including out-of-hospital mortality proportions and hospitalized case-fatality rates. In addition, we compared AMI trends by age, gender and socioeconomic status. METHODS We linked the national Dutch hospital discharge register with the cause of death register to identify first AMI in patients ≥ 35 years between 1998 and 2007. Events were categorized in three groups: 178,322 hospitalized non-fatal, 43,210 hospitalized fatal within 28 days, and 75,520 out-of-hospital fatal AMI events. Time trends were analyzed using Joinpoint and Poisson regression. RESULTS Since 1998, age-standardized AMI incidence rates decreased from 620 to 380 per 100,000 in 2007 in men and from 323 to 210 per 100,000 in 2007 in women. Out-of-hospital mortality decreased from 24.3% of AMI in 1998 to 20.6% in 2007 in men and from 33.0% to 28.9% in women. Hospitalized case-fatality declined from 2003 onwards. The annual percentage change in incidence was larger in men than women (-4.9% vs. -4.2%, P<0.001). Furthermore, the decline in AMI incidence was smaller in young (35-54 years: -3.8%) and very old (≥ 85 years: -2.6%) men and women compared to middle-aged individuals (55-84 years: -5.3%, P<0.001). Smaller declines in AMI rates were observed in deprived socioeconomic quintiles Q5 and Q4 relative to the most affluent quintile Q1 (P=0.002 and P=0.015). CONCLUSIONS Substantial improvements were observed in incidence, out-of-hospital mortality and short-term case-fatality after AMI in the Netherlands. Young and female groups tend to fall behind, and socioeconomic inequalities in AMI incidence persisted and have not narrowed.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Dutch Heart Foundation, The Hague, The Netherlands
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12
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Grau M, Sala C, Sala J, Masia R, Vila J, Subirana I, Ramos R, Elosua R, Brugada R, Marrugat J. Sex-related differences in prognosis after myocardial infarction: changes from 1978 to 2007. Eur J Epidemiol 2012; 27:847-55. [PMID: 22777715 DOI: 10.1007/s10654-012-9712-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/20/2012] [Indexed: 01/19/2023]
Abstract
Women with myocardial infarction (MI) have shown a 28-day survival disadvantage compared with men. However, results were less consistent when considering long-term mortality in 28-day survivors. The aim was to estimate the trends for sex-related differences in the three endpoints considered for this study: (1) 28-day mortality or severe ventricular dysfunction (acute pulmonary oedema or cardiogenic shock) during the hospital stay, (2) 28-day mortality and (3) two-year cardiovascular mortality or non-fatal MI in 28-day survivors after a first MI. A cohort of 3,982 consecutive patients with first Q-wave MI admitted to a university tertiary reference hospital between 1978 and 2007 was followed for 2 years. Short-term prognosis improved in women over the studied period; similar rates were observed in both sexes in the 2000s. After adjusting for age, co-morbidities and anterior location of MI, female sex had an odds ratio=1.71 (95% confidence interval [CI] 1.34-2.17) of short-term severe MI or death over the studied period. Overall, sex differences in long-term prognosis remained similar over the studied period (hazard ratio=1.40; 95% CI 1.02-1.91). In conclusion, short-term prognosis improved over the past 30 years for first Q-wave MI patients, becoming similar for both men and women in the most recent decade. Long-term prognosis did not improve in either men or women, indicating that secondary prevention should be reinforced to achieve consistent reductions in the number of cardiovascular events.
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Affiliation(s)
- María Grau
- Program of Research in Inflammatory and Cardiovascular Disorders (RICAD), Cardiovascular Epidemiology and Genetics, IMIM, 88 Dr Aiguader Street, 08003, Barcelona, Spain
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