American Heart Association. Available at http://www.americanheart.org/statistics/07other.html. Accessed February 2000.

Epidemiology of Acute Myocardial Infarction (AMI)Epidemiology of Acute Myocardial Infarction (AMI)Epidemiology of Acute Myocardial Infarction (AMI)Epidemiology of Acute Myocardial Infarction (AMI)

•Incidence: 1.1 million people/y in the United States

•Of these:– At least one half die within 1 hour of symptom

onset or before reaching the hospital– 24% of men and 42% of women die within 1 year– 66% fail to achieve full recovery– 21% of men and 30% of women develop

congestive heart failure within 6 years

•A 1% reduction in mortality would save 3,400 lives per year

World Health Organization. 1999 World Health Organization Report on Leading Causes of Mortality and Burden of Disease.

AMI: Public Health IssuesAMI: Public Health IssuesAMI: Public Health IssuesAMI: Public Health Issues

• Ischemic heart disease (IHD) is the leading cause of death worldwide (7.4 million/y)

• IHD accounts for 13.7% of all deaths • A 1% reduction in worldwide mortality

would result in >73,000 lives saved per year

PTCA, percutaneous transluminal coronary angioplasty.

0

5

10

15

20

25

30

35

30-D

ay M

ort

alit

y (%

)

5.0%- 6.5%5.0%- 6.5%

13%-15%13%-15%

30%30%

Defibrillation

Hemodynamicmonitoring

-Blockade

Defibrillation

Hemodynamicmonitoring

-BlockadeAspirin, PTCA,

Lysis Aspirin, PTCA,

Lysis

Bed restBed rest

Pre-CCU Era CCU Era Reperfusion Era

Improvement in MortalityImprovement in MortalityImprovement in MortalityImprovement in Mortality

Atypical PresentationsAtypical PresentationsAtypical PresentationsAtypical Presentations

• Patients older than 75: frequently no chest pain• ECG in evolution (nonspecific ECG changes)• Diabetic patients: commonly no chest pain• Stuttering chest pain• Previous AMI • Atypical symptoms