Epidemiology of Acute Myocardial Infarction AMI Incidence 1

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

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

Improvement in Mortality 30% Bed rest 13%-15% Defibrillation Hemodynamic monitoring -Blockade Pre-CCU Era PTCA, percutaneous transluminal coronary angioplasty. CCU Era 5. 0%- 6. 5% Aspirin, PTCA, Lysis Reperfusion Era

Atypical 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