Key result
First major coronary event incidence falls ~47% in Sweden, with steep declines in fatality.
Why the study?
Contemporary reports on population-level trends in coronary events that separately quantify out-of-hospital and in-hospital fatality are limited.
Observational (n=249,630)
Yes
Between 1997 and 2023, Sweden achieved substantial population-level reductions in the incidence and fatality of first major coronary events, though the majority of fatal cases continue to occur out-of-hospital.
Answers are grounded in this paper and cite their sources.
Sustained prevention and acute care efforts remain warranted; extends prior observations of declining coronary event rates in high-income populations.
Background Acute coronary syndromes remain a leading cause of premature mortality. Many fatal events occur before patients reach medical care. Understanding long-term trends in both non-fatal and fatal coronary events is essential for guiding prevention and emergency response strategies. Although declines in coronary events have been reported in many countries, contemporary reports on population-level trends that separately quantify out-of-hospital and in-hospital fatality are limited. Purpose To quantify contemporary population trends in incidence and fatal outcomes of a first major coronary event. Methods The Swedish population register, the cause of death register and the hospital discharge register were linked to identify all individuals aged 18 to 74 years residing in Sweden during 1997 – 2023 who experienced a first major coronary event. Events were defined as out-of-hospital death from coronary artery disease or hospital admission for acute myocardial infarction. In-hospital case fatality was defined as death occurring within 28 days of hospital admission. Annual incidences were age- and sex-standardized to the 2023 Swedish population. Results 249,630 cases of a first major coronary event were identified. The standardised annual incidence of first major coronary events decreased by 42% from 198 to 105 per 100,000 population between 1997 and 2023 (figure 1). Over the same period, standardised annual incidence of case fatality decreased by 71% for out-of-hospital (from 58 to 17 per 100,000) and 67% for in-hospital events (12 to 4 per 100,000). Conclusion Over the past 27 years, Sweden experienced substantial reductions in both the occurrence and fatality of first major coronary events. These trends likely reflect sustained progress in cardiovascular prevention, early detection, and acute care. Despite these improvements, most fatal cases continue to occur out-of-hospital, highlighting the need for enhanced strategies to prevent sudden coronary death and improve early response.
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Lak et al. (2026) conducted an observational in First major coronary event (out-of-hospital death from coronary artery disease or hospital admission for acute myocardial infarction) (n=249,630). Calendar time (2023 vs 1997) vs. 1997 baseline period was evaluated on Standardised annual incidence of first major coronary events and 28-day case fatality (out-of-hospital and in-hospital) per 100,000 population. From 1997 to 2023 in Sweden, first major coronary event incidence fell 42% (198 to 105 per 100,000), while out-of-hospital and in-hospital fatality fell 71% and 67%.
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