Temporal Trends in Incidence and Outcomes of Acute Myocardial Infarction in a Canadian Province: A 23-Year Analysis

Background Contemporary data reporting trends in acute myocardial infarction (AMI) incidence and outcomes remain limited in Canada. We performed a 23-year retrospective analysis of patients with AMI in British Columbia (BC). Methods Retrospective cohort of all AMI patients in BC between 2000 and 2022 using linked provincial administrative datasets. Outcomes included mortality, reinfarction, major adverse cardiovascular events (MACE), incident heart failure (HF), cerebrovascular event (CVE), and chronic kidney disease (CKD). Temporal trends were assessed using linear regression of annual rates. Results The study included 205,017 AMI events among 177,309 unique patients. Annually, 8,913 AMIs occurred on average, comprising 7,378 incident and 1,535 recurrent events. Incident infarctions per capita declined (−6.47 events-per-100,000/year, P<.001), while recurrent infarctions increased (+4.04 events-per-100,000/year, P<.001). Mean age at incident AMI was 70.6±13.7 years and decreased significantly (−0.01 years-of-age/year, P=.004). Hypertension, diabetes, and CKD prevalence at AMI increased, whereas HF and CVE declined (P<.001). All-cause and cardiovascular mortality decreased across all follow-ups (e.g., 1-year all-cause: 23.2% to 17.8%; P≤.001). Post-AMI HF and CVE incidence declined, whereas new-onset CKD increased across all intervals (P<.001). Conclusions Over two decades, BC AMI patients presented younger with greater metabolic comorbidity, but exhibited improved cardiovascular outcomes. Most improvements occurred in the first decade of the study. Non-cardiovascular mortality, recurrent infarction, and post-MI CKD are rising. These trends highlight the need for emphasis on primary prevention and multi-system care.