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Changing clinical presentation and outcome of acute myocardial infarction in New Jersey from 1990-2004
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Title
Changing clinical presentation and outcome of acute myocardial infarction in New Jersey from 1990-2004
Name
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Shao
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Yu-Hsuan
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Yu-Hsuan Shao
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author
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Rhoads
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George
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Advisory Committee
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George G Rhoads
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chair
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Demissie
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Kitaw
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Advisory Committee
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Kitaw Demissie
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internal member
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Marcella
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Stephen
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Advisory Committee
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Stephen W Marcella
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internal member
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Kostis
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John
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Advisory Committee
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John B Kostis
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outside member
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Rutgers University
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degree grantor
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Graduate School - New Brunswick
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theses
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2008
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2008-10
Language
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English
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electronic
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ix, 79 pages
Abstract
Over the past few decades, there has been a dramatic decline in coronary heart disease (CHD) mortality in the face of relatively stable incidence of acute myocardial infarction (AMI). However, the clinical presentation of AMI has been changing with more infarcts classified as subendocardial.
Objective
To explore closely the change from 1990 to 2004 in the incidence and presentation of hospitalized AMI, its case fatality, and the relationship of these changes to the decline in overall CHD mortality.
Design, Setting, and Participants
I studied hospitalized AMI cases in New Jersey from 1990-2004 (n=222,944) matched to state death records. The ECG and enzyme presentation of AMI was examined for 1990-1993 and 2001-2004 in 416 patient hospital records.
Results
CHD mortality declined by 40.8% from 1351 to 799 per 100,000, mostly in persons without an AMI hospitalization in the preceding 4-12 years. However, AMI hospitalization rate was relatively stable. The QMI hospitalization rate declined by approximately 50% in every age group; in contrast, the NQMI hospitalization rate increased 2 to 3 fold in each age group. Crude in-hospital case-fatality decreased from 13.4% in 1990 to 8.8% in 2004 for QMI patients while it increased slightly for NQMI. The 1-year case fatality of QMI decreased from 22.5% in 1990 to 17.8% in 2004 but the 1-year case fatality of NQMI patients increased from 18.3% in 1990 to 23.7% in 2004. Hospital record reviews confirmed a substantial decrease in the frequency of ST elevation and Q wave development in AMI admissions across the study period.
A decline in cardiovascular disease (CVD) case-fatality and a marked increase in NCVD case-fatality in four years were observed. The decline in CVD deaths might be attributed by the mix of cases which included milder MIs detected by troponins and possibly more severe cases that underwent revascularization before Q wave develop. One of the contributors to this increasing trend in NCVD deaths might be diabetes, which is known to be associated with higher mortality for both CVD and NCVD. The increasing prevalence of DM may play a significant role in increasing overall deaths, especially among patients following subendocardial infarction.
Conclusion
Changing clinical presentation of AMI and a worsening prognosis of subendocardial infarction suggest that the pathogenesis of CHD changed significantly during the 15 year study period. The worsening prognosis of subendocardial AMI deserves attention.
Objective
To explore closely the change from 1990 to 2004 in the incidence and presentation of hospitalized AMI, its case fatality, and the relationship of these changes to the decline in overall CHD mortality.
Design, Setting, and Participants
I studied hospitalized AMI cases in New Jersey from 1990-2004 (n=222,944) matched to state death records. The ECG and enzyme presentation of AMI was examined for 1990-1993 and 2001-2004 in 416 patient hospital records.
Results
CHD mortality declined by 40.8% from 1351 to 799 per 100,000, mostly in persons without an AMI hospitalization in the preceding 4-12 years. However, AMI hospitalization rate was relatively stable. The QMI hospitalization rate declined by approximately 50% in every age group; in contrast, the NQMI hospitalization rate increased 2 to 3 fold in each age group. Crude in-hospital case-fatality decreased from 13.4% in 1990 to 8.8% in 2004 for QMI patients while it increased slightly for NQMI. The 1-year case fatality of QMI decreased from 22.5% in 1990 to 17.8% in 2004 but the 1-year case fatality of NQMI patients increased from 18.3% in 1990 to 23.7% in 2004. Hospital record reviews confirmed a substantial decrease in the frequency of ST elevation and Q wave development in AMI admissions across the study period.
A decline in cardiovascular disease (CVD) case-fatality and a marked increase in NCVD case-fatality in four years were observed. The decline in CVD deaths might be attributed by the mix of cases which included milder MIs detected by troponins and possibly more severe cases that underwent revascularization before Q wave develop. One of the contributors to this increasing trend in NCVD deaths might be diabetes, which is known to be associated with higher mortality for both CVD and NCVD. The increasing prevalence of DM may play a significant role in increasing overall deaths, especially among patients following subendocardial infarction.
Conclusion
Changing clinical presentation of AMI and a worsening prognosis of subendocardial infarction suggest that the pathogenesis of CHD changed significantly during the 15 year study period. The worsening prognosis of subendocardial AMI deserves attention.
Note
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Ph.D.
Note
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Includes bibliographical references (p. 72-78).
Subject
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Topic
Public Health
Subject
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Topic
Coronary heart disease--Patients
Subject
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Topic
Myocardial infarction--Patients
Subject
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Topic
Outcome assessment (Medical care)
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Graduate School - New Brunswick Electronic Theses and Dissertations
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rucore19991600001
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http://hdl.rutgers.edu/1782.2/rucore10001600001.ETD.17566
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ETD_1170
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doi:10.7282/T3ZG6SJK
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ETD doctoral
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The author owns the copyright to this work.
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Open
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Yu-Hsuan Shao
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Rutgers University. Graduate School - New Brunswick
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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