Twenty–five–year Trend in Epidemiology and Outcome of Acute Myocardial Infarction

Aim Trends in acute myocardial infarction (AMI) epidemiology and care at the population level provide insight into the effectiveness of healthcare systems. In this study, we aim to evaluate 25–year trends in AMI hospitalizations, management and outcomes, in the Veneto Region (Italy) population. Methods We conducted a retrospective, population–based analysis of all hospital discharge records from 2000 to 2024. AMI cases were classified as ST–Elevation myocardial infarction (STEMI) or Non–ST–Elevation myocardial infarction (NSTEMI) using ICD9–CM codes. Hospitalization rates, key care process indicators and 30–day mortality were estimated. The average annual percentage change (AAPC) and relative 95% confidence interval (CI) were calculated to identify trends. Results Over the study period, 167,277 patients were hospitalized for AMI in the Veneto Region. STEMI accounted for 57.3% of cases (mean age: 70.6 ± 13.9 years), and NSTEMI for the remaining 42.7% (mean age: 72.4 ± 12.8 years). Age–standardized hospitalization rates of AMI declined during the study period from 151.1 to 98.8 per 100,000 inhabitants [AAPC: −2.30%, (95% CI: −2.63 to −2.01), p‹0.001], driven by reductions in STEMI [AAPC: −4.72%, (95% CI: −5.20 to −4.34), p‹0.001], while NSTEMI increased [AAPC: +1.05%, (95% CI: 0.25 to 1.86), p=0.011] and became predominant from 2016 onward (Figure 1). Admissions in specialized cardiology wards (ordinary or intensive care) increased over time, especially among STEMI patients [from 68.7% in 2000 to 85.1% in 2024; AAPC: +0.85% (95% CI: 0.68 to 1.03), p‹0.001]. Moreover, same–day PCI among STEMI patients increased markedly from 8.0% in 2000 to 72.3% in 2024 [AAPC: +6.41%, (95% CI: 5.36 to 8.20), p‹0.001] (Figure 2). The age–standardized 30–day mortality rate declined continuously throughout the 25–year period both for STEMI (from 19.3% in 2000 to 13.2% in 2024) and for NSTEMI (from 10.0% to 5.1% in the same period) (Figure 3). Conclusions Over 25 years, AMI in the Veneto Region shifted from STEMI– to NSTEMI–dominance, with improved procedural access and outcomes.