ST elevation myocardial infarction epidemiology and demographics

Jump to: navigation, search

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

Home

Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Cardiac MRI

Echocardiography

Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Antithrombins
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Overview
Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

ST elevation myocardial infarction epidemiology and demographics On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on ST elevation myocardial infarction epidemiology and demographics

CDC on ST elevation myocardial infarction epidemiology and demographics

ST elevation myocardial infarction epidemiology and demographics in the news

Blogs on ST elevation myocardial infarction epidemiology and demographics

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for ST elevation myocardial infarction epidemiology and demographics

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]

This means that roughly every 65 seconds, an American dies of a coronary event.

Incidence

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 [5]. 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 [6]

Prevalence

The following prevalence estimates are for people age 18 and older from NCHS/NHIS, 2005: [7]

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% [6]. 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 [8].

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 [9], improvements in time to reperfusion (door-to-needle and door-to-balloon times) [10][11] and improved medical therapy, including increases in the use of evidence-based therapies such as aspirin [12], beta blockers[13] [14], clopidogrel [15], statins [16] and angiotension converting enzyme inhibitors or angiotensin receptor blockers [17].

References

  1. "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)
  2. 2008 Heart Disease and Stroke Statistics
  3. 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. PMID 17679616. doi:10.1161/CIRCULATIONAHA.107.181940.  Unknown parameter |month= ignored (help)
  4. 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. PMID 17692738. doi:10.1016/j.jacc.2007.02.013.  Unknown parameter |month= ignored (help)
  5. 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. PMID 15358047. doi:10.1016/j.jacc.2004.07.014.  Unknown parameter |month= ignored (help)
  6. 6.0 6.1 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)
  7. Vital Health Stat 10.2006 [232]: 1–153
  8. 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. PMID 17473299. doi:10.1001/jama.297.17.1892.  Unknown parameter |month= ignored (help)
  9. 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)
  10. 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. PMID 16750682. doi:10.1016/j.jacc.2005.12.072.  Unknown parameter |month= ignored (help)
  11. 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. PMID 17591643. doi:10.1136/hrt.2006.112847.  Unknown parameter |month= ignored (help)
  12. "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)
  13. "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)
  14. "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)
  15. 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. PMID 15758000. doi:10.1056/NEJMoa050522.  Unknown parameter |month= ignored (help)
  16. 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. PMID 15007110. doi:10.1056/NEJMoa040583.  Unknown parameter |month= ignored (help)
  17. 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)

Linked-in.jpg