What is the clinical evidence from this study?

Study design: Observational. Population: Acute Myocardial Infarction (n=1587). Intervention: ST-elevation myocardial infarction (STEMI) vs. Non-ST-elevation myocardial infarction (NSTEMI). Primary outcome: In-hospital mortality (p=<0.001).

December 28, 2022Open Access

Incidence and In-Hospital Mortality of Acute Myocardial Infarction: A Report from a Population-Based Registry in Japan

Q: What are the key findings of this study?

The age-adjusted incidence rate of acute myocardial infarction was 61.9 per 100,000 person-years, with age-adjusted in-hospital mortality remaining high at 12.3% for STEMI compared to 5.8% for NSTEMI.

YSYuichi SawayamaShiga University of Medical Science NTNaoyuki TakashimaShiga University of Medical Science AHAkiko HaradaShiga University of Medical Science

Key Result

The age-adjusted incidence rate of acute myocardial infarction was 61.9 per 100,000 person-years, with age-adjusted in-hospital mortality remaining high at 12.3% for STEMI compared to 5.8% for NSTEMI.

Study Design

Type

Observational (n=1,587)

Multicenter

Yes

Structured PICO

Population

1,587 patients with acute myocardial infarction diagnosed by the Universal Definition of Myocardial Infarction in Shiga Prefecture, Japan, evaluated for incidence and in-hospital mortality.

Outcome

Incidence rate of AMI and in-hospital mortalityhard clinical

The application of the Universal Definition of Myocardial Infarction in a Japanese population-based registry revealed an age-adjusted AMI incidence of 61.9 per 100,000 person-years and highlighted persistently high in-hospital mortality for STEMI patients.

Main Result

Absolute Event Rate: 12.1% vs 5.7%

p-value: p=<0.001

Limitations

Lack of information on patients with AMI who visited hospitals outside Shiga Prefecture or clinics not covered by the study, potentially underestimating incidence.
Death-certificate-only (DCO) cases were excluded from the incidence calculation, which may underestimate the actual incidence rates.
In-hospital mortality potentially varies by hospital and cannot be compared uniformly.

Abstract

AIM: To investigate the incidence and in-hospital mortality of acute myocardial infarction (AMI) by conforming to the Universal Definition of Myocardial Infarction (UDMI) in a population-based registry. METHODS: The Shiga Stroke and Heart Attack Registry is a multicenter, population-based registry in the Shiga Prefecture, designed to evaluate the incidence and prognosis of acute cerebro-cardiovascular diseases. We registered patients with AMI as defined by the UDMI, who developed AMI from January 2014 to December 2015 in the Shiga Prefecture. The incidence rate of AMI was calculated and standardized for age by a direct method using the 2015 Japanese population. We also evaluated the in-hospital mortality among hospitalized patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). RESULTS: A total of 1,587 patients were diagnosed with AMI, and the age-adjusted incidence rate was 61.9 per 100,000 person-years. The proportions of patients with STEMI, NSTEMI, and type 3 myocardial infarction were 57%, 30%, and 12%, respectively. The incidence rates of AMI increased with age regardless of sex, which was the highest in those 85 years and older, with 389.7 per 100,000 person-years in men and 221.8 per 100,000 person-years in women. Age-adjusted in-hospital mortality among hospitalized patients with STEMI and NSTEMI was 12.3% and 5.8%, respectively. CONCLUSIONS: This population-based registry clarified the age-adjusted incidence rate of AMI under the application of the UDMI, highlighting that in-hospital mortality is still high among patients with STEMI in Japan.

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