Key result
The 28-day case-fatality was sixfold greater for incident myocardial infarction than for all ischemic heart disease (12.0% vs 2.0%), alongside low rates of coronary revascularization (39%).
Why the study?
Myocardial infarction is a major cause of premature death and disability in China, but data on its diagnostic accuracy, treatment, and prognosis remain limited.
Does incident myocardial infarction result in worse prognosis compared to all ischemic heart disease in a community-based Chinese cohort?
Cohort (n=512,000)
Yes
Does incident myocardial infarction result in worse prognosis compared to all ischemic heart disease in a community-based Chinese cohort?
Answers are grounded in this paper and cite their sources.
Highlights significant short- and long-term diagnostic, treatment, and prognostic disparities for MI versus overall IHD in China, emphasizing the need for improved access to revascularization.
Introduction Myocardial infarction (MI) is a major cause of premature death and disability in China, but available data on diagnostic accuracy, treatment and prognosis of MI cases remain limited. Methods The China Kadoorie Biobank enrolled 512 000 adults (mean age 51 years, 59% women) from 10 (five urban, five rural) areas between 2004 and 2008. Medical records were sought on 37 159 reported first incident ischaemic heart disease (IHD) cases occurring before 2018 for adjudication. Diagnostic accuracy and risks of recurrent MI, stroke, heart failure and all-cause mortality were assessed for reported and adjudicated cases of MI and all IHD. Results Among 19 135 adjudicated IHD cases, 10.2% (n=1948) had MI, with diagnostic accuracy of 98% for MI and 93% for all IHD. Use of guideline-directed (antiplatelet, lipid-lowering, antihypertensive and anticoagulant) medications in the hospital was high (93% MI; 83% all IHD), but differed by hospital tier and area. Use of coronary revascularisation was low (39% MI; 10% all IHD), even in higher tier hospitals. The 28-day case-fatality was sixfold greater for MI than all IHD (12.0% vs 2.0%) and higher in older cases and in women, residents in rural areas, but comparable by hospital tier. Disparities in 5-year mortality rates persisted for both MI and all IHD, by age, sex, area and hospital tiers. Conclusions This large community-based prospective study demonstrated high levels of diagnostic accuracy for MI and all IHD in Chinese adults, but also identified disparities in treatment and outcomes that should be prioritised in future prevention strategies.
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Turnbull et al. (2026) conducted a cohort in Ischemic heart disease and myocardial infarction (n=512,000). Incident myocardial infarction (MI) vs. All incident ischemic heart disease (IHD) was evaluated on 28-day case-fatality rate. The 28-day case-fatality was sixfold greater for incident myocardial infarction than for all ischemic heart disease (12.0% vs 2.0%), alongside low rates of coronary revascularization (39%).
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