Background: Declining mortality rates of coronary heart disease in the United States could be attributable to declining incidence, declining severity, and/or improvements in treatment. Methods: We examined trends in severity of patients hospitalized for myocardial infarction to characterize its contribution to this decline by using data from the Atherosclerosis Risk in Communities (ARIC) study. Results: No significant change in the proportion having systolic blood pressure <100 mm Hg or an abnormal pulse at presentation was noted. The proportion with ST-segment elevation on the initial electrocardiogram increased 10% per year (P < .001), and the proportion with a diagnostic or evolving diagnostic electrocardiogram abnormality increased 4% per year (P < .01); the proportion that had a new Q- wave infarction develop remained unchanged. The mean peak creatine kinase level decreased 5% per year (P < .001), the proportion with abnormal enzyme levels decreased 10% per year (P < .001), and the proportion that met criteria for definite myocardial infarction decreased 4% per year (P < .05). The proportion that had cardiogenic shock decreased 10.9% per year (P < .01), but the proportion that had an acute episode of congestive heart failure was stable. Conclusions: With stable hemodynamic indicators, worsening electrocardiographic indicators, and improving enzymatic indicators, these results provide mixed support for decreases in the severity of myocardial infarction.
Bibliographical noteFunding Information:
From the awoke Forest University School of Medicme, Winston-Salem; &Jniversity of Minneroto, Minneapolis; CUniver~~ty of North Corolmo, Chapel HIII; and the dNa-tionol Heart, Lung ond Blood Institute, Bethesda. Supported by contracts NOI-HC-55015, NO I-HC.550 16, NO I-HC-55018, NOI-HC-55019, NOI-HC-55020, NOI-HC-55021, and NOI-HC-55022 from the Notional Heori, lung, ond Blood Institute. Submitted February 24, 1999; accepted October 26, 1999. Reprint requests: David Gaff, MD, Woke Forest Unwers~~ School of Medicine, Medical Center Blvd. Winston-Salem, NC 27 I5 7.1063. E-mail: email@example.com Copyright Q 2000 by Morby, Inc. 0002.8703/2000/$12.00+0 doi: IO. 1067/mh;.2000. IO6 I6 I
Copyright 2017 Elsevier B.V., All rights reserved.