Large series from around the Western world have consistently shown falling mortality and morbidity from cardiovascular disease but less information is available about age- and sex-specific outcomes and their changes in the recent past.

In this study Nguyen et al examine the 20-year trends in patients hospitalized with acute myocardial infarction (AMI) in over 10,000 patients in central Massachusetts.  Analysing data from 5,907 males and 4,406 females presenting with AMI between 1986 and 2005, the authors divide patients by age and examine the development of complications following AMI including atrial fibrillation, heart failure, cardiogenic shock and 30 day mortality.

Interestingly, while older patients predictably and consistently have higher levels of complications in general, men and women diverge with atrial fibrillation becoming more common in men aged over 75yrs (P=0.04), while proportionally greater numbers of younger men (<65 yrs) are now presenting with cardiogenic shock (P=0.001) suggesting a change in myocardial infarction characteristics over time.  In women no such trends are seen with the risk of developing these major complications after AMI not having changed significantly over time.  While mortality in all age groups has been declining with time, confirming trends seen in other cohorts, age differences in short-term mortality have remained relatively unchanged over the past 20 years in both sexes with the elderly at high risk for adverse outcomes.

Conclusions

20 year trends in myocardial infarction suggest cardiogenic shock is proportionally more common in younger men today but that both elderly men and women are still more likely to experience adverse short-term outcomes after AMI.  Better knowledge of at risk groups and more targeted treatment approaches during hospitalization for AMI and thereafter may help to improve prognosis.

• Nguyen HL, Saczynski JS, Gore JM et al.  Long-term Trends in Short-term Outcomes in Acute Myocardial Infarction.  Am J Med 2011;124:939-46.