ACUTE MYOCARDIAL INFARCTION
Category: Cardiology Heart Health
Abstract :
More than 1.1 million patients have an acute myocardial infarction (MI) in the United States (US) annually, and more than 50% of these patients die within the first hour, caused mainly by arrhythmias, particularly ventricular fibrillation (VF). Of those admitted to a hospital, approximately 15% die during hospitalization. In addition, more than 1 million patients with symptoms suggestive of acute
More than 1.1 million patients have an acute myocardial infarction (MI) in the United States (US) annually, and more than 50% of these patients die within the first hour, caused mainly by arrhythmias, particularly ventricular fibrillation (VF). Of those admitted to a hospital, approximately 15% die during hospitalization.
In addition, more than 1 million patients with symptoms suggestive of acute MI are admitted annually to coronary care units (CCUs). In the year 2000, more than 12 million people worldwide died because of cardiovascular disorders mainly caused by the disease atheroma and subsequent thrombosis (atherothrombosis). It is estimated that by the year 2020, more than 24 million people will die annually from this disease in a world population of approximately 7.4 billion.
Intensive research is required to prevent atherothrombosis rather than the management of its complications, which include fatal and nonfatal heart attack, angina, heart failure (HF), abdominal aortic aneurysm, stroke, kidney failure, peripheral vascular disease causing intermittent claudication, and gangrene of the lower limb. Most research done in major institutions in the US and in developed countries is directed at the management of complications of atherosclerotic coronary artery disease (CAD). The worldwide advent of CCUs in the early 1970s, thrombolytic agents in the late 1980s, coronary angioplasty in the 1980s and 1990s, and stents during the past decade have improved survival but this can be considered as modest. Most importantly, the development of left ventricular (LV) assist devices (that are clearly a bridge to transplantation and not artificial hearts) requires considerable financial support for their development. They will save less than 1000 lives annually worldwide because these devices are not artificial hearts and their success depends on the ability to obtain donor hearts, of which, there are presently less than 4000 worldwide.
Obstructive atherosclerotic CAD leads to the following:
• Stable or unstable angina.
• Fatal or nonfatal MI.
• Sudden death.
• HF.
• Arrhythmias, atrial fibrillation, and thromboembolism that may cause stroke.
Approximately 20 million Americans have coronary heart disease, close to 7 million of whom have angina and more than 10 million have had a heart attack. The approximate economic cost of CAD and stroke in North America is approximately $350 billion, with roughly $120 billion for CAD. Although there has been a mild decrease in the incidence of CAD in North America during the past decade, the disease process and its complications are expected to increase because of an aging population.
Unfortunately in developing countries, the prevalence of CAD and its complications have increased in the past decade, and it is estimated that by 2020 cardiovascular disease (CVD) will reach epidemic proportions worldwide. It is relevant that developing countries constitute more than 80% of the worlds population and in these regions, particularly in India and other Asian countries, the incidence of CAD is on the increase. The high incidence of communicable, maternal, perinatal and nutritional diseases in these countries will fall from roughly 41 to near 17% but CVDs will increase from about 20% to more than 33% over the next 20 years. Japan is unique among the developed countries in that although the stroke rates were the highest in the world during the 1960s, the incidence did not rise as sharply as in other developed countries and have remained lower. In Japan, CVD rates have fallen more than 60% since the 1960s, largely because of a decrease in stroke rates. Life expectancies for men and women are the highest in the world and reach 77 years for men and 83 years for women.
The CAD mortality per 100,000 men and women respectively in countries where data is available is as follows:
• Russian Federation: 767 and 288.
• Ukraine: 749 and 342, yet in the neighboring Slovenia the mortality rate is low.
• Scotland: 655 and 273.
• Finland: 631 and 587.
• Portugal: 207 and 73.
• Spain: 181 and 52.
• France: enjoys the lowest cardiovascular mortality of all the developed countries; also, the CAD mortality is low: 142 and 36.
CVD mortality rates in Canada, New Zealand, and Australia are similar to those in the US.
Prevention
Yusuf et al. reported on an extensive case-control study in 52 countries. Nine modifiable risk factors were all significantly related to acute myocardial infarction:
• abnormal lipids
• smoking
• hypertension
• diabetes
• abdominal obesity
• psychosocial factors
• lack of daily comsumption of fruits and vegetables
• regular physical activity
• regular alcohol consumption
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