Coronary artery disease
Rate of Acute ST-Elevation Myocardial Infarction in the United States from 1988 to 2004 (from the Nationwide Inpatient Sample)

https://doi.org/10.1016/j.amjcard.2009.02.058Get rights and content

Advances in the management of atherosclerosis risk factors have been dramatic in the previous 10 years. The goal of this study was to evaluate any decrease in age-adjusted incidence of acute ST-elevation myocardial infarction (STEMI) in a very large database of inpatient admissions from 1988 to 2004. The Nationwide Inpatient Sample database was used to calculate the age-adjusted rate for STEMI from 1988 to 2004 retrospectively. Specific International Classification of Diseases, Ninth Revision, codes for MIs consistent with STEMI were used. Patient demographic data were also analyzed and adjusted for age. The Nationwide Inpatient Sample database contained 1,352,574 patients >40 years of age who had a diagnosis of STEMI from 1988 to 2004. Mean age for these patients was 66.06 ± 13.69 years. Men had almost 2 times the age-adjusted STEMI rate as women (men 62.4%, women 37.6%). From 1988 the age-adjusted rate for all acute STEMIs remained steady for 8 years (108.3 per 100,000, 95% confidence interval [CI] 99.0 to 117.5, in 1988 and 102.5 per 100,000, 95% CI 94.7 to 110.4, in 1996). However, from 1996 onward, the age-adjusted incidence of STEMI steadily decreased to 1/2 the incidence of the previous 8 years (50.0 per 100.000, 95% CI 46.5 to 53.5, by 2004, p <0.01). This decrease was similar across various races and genders. In conclusion, the incidence of STEMI was stable from 1988 to 1996, with a steady linear decrease to 1/2 by 2004. The cause of the steady decrease in STEMI rate most likely reflects the advancement in management of patients with atherosclerosis.

Section snippets

Methods

The NIS is a set of longitudinal hospital inpatient databases included in the Healthcare Cost and Utilization Project. These databases are created by the Agency for Healthcare Research and Quality through a federal–state–industry partnership. Healthcare Cost and Utilization Project data inform decision-making at the national, state, and community levels. Researchers and policymakers use the NIS to identify, track, and analyze national trends in health care use, access, charges, quality, and

Results

The NIS database contained information on 1,352,574 patients who had a diagnosis of STEMI from 1988 to 2004 and were 40 years of age. Mean age for these patients was 66.06 ± 13.69 years. Men had almost 2 times the age-adjusted STEMI rate as women (men 62.4%, women 37.6%). From 1988 the age-adjusted rate for all acute STEMIs remained steady for 8 years (108.32 per 100,000, 95% CI 99.0 to 117.5, in 1988 and 102.5 per 100,000, 95% CI 94.7 to 110.4, in 1996). However, from 1996 onward, the

Discussion

A recent report from the National Center for Health Statistics showed that there were 1,565,000 hospitalizations due to an acute coronary syndrome in 2004. Among them, 669,000 were admitted for unstable angina pectoris and 896,000 for MI.1 Cardiovascular disease is 1 of the major reasons for visits to the emergency department; in 2003 this accounted for approximately 4,497,000 visits.1 Our study included 1,352,574 patients who had a diagnosis of STEMI from 1988 to 2004 in the NIS database.

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