Key result
Cardiovascular and overall comorbidity prevalence (49.6% overall) in AMI patients significantly decreased from 2004 to 2021 (p<0.001), alongside reduced in-hospital mortality.
Why the study?
Little was known about temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities among patients presenting with acute myocardial infarction.
Observational (n=48,848)
Over a 17-year period, the prevalence of comorbidities in patients presenting with acute myocardial infarction significantly decreased—except for non-cardiovascular comorbidities in women—which likely contributed to observed improvements in in-hospital survival.
Decreasing comorbidity prevalence was associated with lower AMI in-hospital mortality; leaves open whether trends reflect prevention gains or selection effects.
Background Little is known about temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction (AMI). Methods AMIS Plus registry patients enrolled between 2004 and 2021 were stratified based on comorbidities in 3 groups: (1) «cardiovascular comorbidity»: at least one among past history of myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, heart failure, peripheral vascular disease, cerebrovascular disease, or atrial fibrillation; (2) «non-cardiovascular comorbidity»: at least one among dementia, chronic lung disease, connective tissue disease, peptic ulcer disease, moderate or severe renal disease, diabetes, liver disease, or cancer disease; and (3) «any comorbidity»: at least one of the mentioned comorbidities. Prevalence and mortality were analysed according to the type of comorbidity in 2-year periods and stratified by sex. Temporal trends were analysed using the Mantel-Haenszel linear-by-linear association Chi-squared test. Results Among the 48’848 patients enrolled, 24’215 (49.6%) had at least one comorbidity. Of these, 17’441 (72.0%) were male and 6’774 (28.0%) female. Over the years, there was a significant decrease in the prevalence of «any comorbidity» (p<0.001) as well as «cardiovascular comorbidity» (p<0.001). A significant decrease in the prevalence of «any comorbidity» as well as «cardiovascular comorbidity» was detected for both sexes. With respect to the prevalence of «non-cardiovascular comorbidity», a significant reduction over time was observed in men but not in women. The reduction of in-hospital mortality over time was significant across all groups, overall and for both sexes individually. Conclusions Over more than a decade, a significant reduction in the prevalence of comorbidities was observed in patients presenting with AMI, with the exception of non-cardiovascular comorbidities in women. This reduction may have contributed, in addition to the improvements in pharmacologic treatments as well as in revascularization, to the improved survival observed over time.
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Stähli et al. (2023) conducted an observational in Acute myocardial infarction (n=48,848). Cardiovascular and non-cardiovascular comorbidities vs. No comorbidities / temporal comparison across 2-year periods from 2004 to 2021 was evaluated on Temporal trends in the prevalence of comorbidities and in-hospital mortality (p=<0.001). Cardiovascular and overall comorbidity prevalence (49.6% overall) in AMI patients significantly decreased from 2004 to 2021 (p<0.001), alongside reduced in-hospital mortality.
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