What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=79172). Intervention: Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI). Primary outcome: 5-year survival rate.

August 2, 2023Open Access

Incidence, mortality and disability-adjusted life years of acute myocardial infarction in Kazakhstan: data from unified national electronic healthcare system 2014–2019

Key Result

Coronary artery bypass grafting yielded higher survival rates compared to percutaneous coronary intervention (86.3% vs 80.9%) during a 5-year follow-up in patients with acute myocardial infarction.

Study Design

Type

Cohort (n=79,172)

Multicenter

Yes

Structured PICO

Population

79,172 patients admitted to hospital with acute myocardial infarction (ICD-10 diagnosis I21) in Kazakhstan between 2014 and 2019, mean age 63, 67% male.

Outcome

Incidence, mortality, and disability-adjusted life years (DALYs) of acute myocardial infarctionhard clinical

The burden of acute myocardial infarction in Kazakhstan is substantial and increasing, highlighting the need for improved disease management and preventive measures.

Main Result

Absolute Event Rate: 86.3% vs 80.9%

Limitations

Use of hospitalization records only captures a subset of AMI cases and does not account for pre-hospital morbidity and mortality
Database lacks information on important factors such as tobacco use, cholesterol levels, obesity, and family history
Potential for errors during disease coding
Lack of cause of death information restricts calculation of cause-specific mortality rates

Abstract

Background: Cardiovascular diseases contribute to premature mortality globally, resulting in substantial social and economic burdens. The Global Burden of Disease (GBD) Study reported that in 2019 alone, heart attack and strokes accounted for the deaths of 18.6 million individuals. Ischemic heart diseases, including acute myocardial infarction (AMI), accounted for 182 million disability-adjusted life years (DALYs) and it is leading cause of death worldwide. Aim: The aim of this study is to present the burden of AMI in Kazakhstan and describe the outcome of hospitalized patients. Methods: The data of 79,172 people admitted to hospital with ICD-10 diagnosis I21 between 2014 and 2019 was derived from the Unified National Electronic Health System and retrospectively analyzed. Results: The majority of the cohort (53,285, 67%) were men, with an average age of 63 (±12) years, predominantly of Kazakh (38,057, 48%) and Russian (24,583, 31%) ethnicities. Hypertension was the most common comorbidity (61,972, 78%). In males, a sharp increase in incidence is present after 40 years, while for females, the morbidity increases gradually after 55. Throughout the observation period, all-cause mortality rose from 101 to 210 people per million population (PMP). In 2019, AMI account for 169,862 DALYs in Kazakhstan, with a significant proportion (79%) attributed to years of life lost due to premature death (YLDs). Approximately half of disease burden due to AMI (80,794 DALYs) was in age group 55-69 years. Although incidence is higher for men, they have better survival rates than women. In terms of revascularization procedures, coronary artery bypass grafting yielded higher survival rates compared to percutaneous coronary intervention (86.3% and 80.9% respectively) during the 5-year follow-up. Conclusion: This research evaluated the burden and disability-adjusted life years of AMI in Kazakhstan, the largest Central Asian country. The results show that more effective disease management systems and preventive measures at earlier ages are needed.

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