Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry

This study examines epidemiological trends of acute myocardial infarction (AMI) in Germany from 2004–2015 across different age groups, using data of the population-based KORA myocardial infarction registry. Annual age-standardised, age-group- and sex-specific mortality and event rates (incident and recurrent) per 100,000 population as well as 28-day case fatality were calculated from all registered cases of AMI and coronary heart disease deaths in 25–74-year-olds from 2004–2015 and 75–84-year-olds from 2009–2015. Average annual percentage changes (AAPC) were calculated by joinpoint regression. Mortality rates declined considerably among the elderly (75–84 years), in men by –6.0% annually, due to declines of case fatality by –3.0% and incidence rate by 3.4% and in women by –10.0%, driven by declines in incidence (–9.1%) and recurrence rate (–4.9%). Significant mortality declines also occurred in males, 65–74 years of age (AAPC –3.8%). Among the age groups 25–54 years and 55–64 years, there was no substantial decline in mortality, event rates or case fatality except for a decline of incidence rate in 55–64-year-old men (AAPC –1.8%). Inhomogeneous AMI trends across age-groups indicate progress in prevention and treatment for the population >64 years, while among <55-year-olds, we found no significant trend in AMI morbidity and mortality.KEY MESSAGESAge standardised AMI mortality continued to decline from 2009 to 2015 in the study region.Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality.AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75–84 years of age). Age standardised AMI mortality continued to decline from 2009 to 2015 in the study region. Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality. AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75–84 years of age).

本研究依托以人群为基础的KORA心肌梗死登记库（KORA myocardial infarction registry）数据，对2004—2015年德国不同年龄组急性心肌梗死（acute myocardial infarction, AMI）的流行病学趋势展开分析。研究纳入2004—2015年25~74岁人群、2009—2015年75~84岁人群中所有登记在册的AMI病例与冠心病死亡病例，据此计算每10万人口的年度年龄标化、年龄别与性别特异性死亡率、事件发生率（首发与复发事件）以及28天病死率。本研究采用连接点回归（joinpoint regression）计算年度平均百分比变化（average annual percentage changes, AAPC）。
结果显示，老年人群（75~84岁）的死亡率显著下降：男性年降幅达6.0%，其下降由病死率降低3.0%与发病率下降3.4%共同驱动；女性年降幅为10.0%，源于发病率（9.1%）与复发率（4.9%）的下降。65~74岁男性群体同样出现显著的死亡率下降（AAPC为-3.8%）。而25~54岁与55~64岁年龄组的死亡率、事件发生率及病死率均无明显下降，仅55~64岁男性的发病率出现小幅降低（AAPC为-1.8%）。不同年龄组间AMI趋势存在异质性，提示64岁以上人群的预防与治疗工作已取得进展；而55岁以下人群的AMI发病率与死亡率未出现显著变化趋势。
KEY MESSAGES
年龄标化的AMI死亡率在研究区域内2009—2015年间持续下降。AMI死亡率的下降源于事件发生率（包括首发与复发率）及病死率的降低。不同年龄组的AMI趋势并不一致，老年人群（75~84岁）的死亡率与事件发生率降幅最为显著。年龄标化的AMI死亡率在研究区域内2009—2015年间持续下降。AMI死亡率的下降源于事件发生率（包括首发与复发率）及病死率的降低。不同年龄组的AMI趋势并不一致，老年人群（75~84岁）的死亡率与事件发生率降幅最为显著。