ST-Segment Elevated Acute Myocardial Infarction: Changing Profile Over Last 24 Years

Area of Science:

• Cardiology and Cardiovascular Diseases
• Public Health and Epidemiology

Background:

• Coronary artery disease (CAD) is a growing epidemic in India, characterized by early onset and numerous risk factors.
• Understanding the profile of acute ST-segment elevated myocardial infarction (STEMI) is crucial for public health initiatives.

Purpose of the Study:

• To comprehensively analyze the demographic profile, risk factors, clinical presentation, treatments, and outcomes of acute STEMI patients in India.
• To track the changing trends and profile of STEMI over a 24-year period.

Main Methods:

• A cross-sectional study involving 45,122 acute STEMI patients admitted between March 1990 and March 2014.
• Data collection included detailed clinical history, physical examination, laboratory parameters, therapeutic interventions, and in-hospital outcomes.

Main Results:

• STEMI patients presented at a mean age of 56.34 years, with 82.48% being male. Key risk factors included urban residency, lower education, middle/low socioeconomic status, unemployment, lack of exercise, poor diet, smoking, obesity, diabetes, hypertension, hyperlipidemia, and family history.
• Anterior wall STEMI was most common (56.78%). Less than half presented within 12 hours, and only 0.8% within 1 hour. Complications included CHF (34.7%), cardiogenic shock (8.65%), reinfarction (6.5%), arrhythmia (59.2%), and a 10.57% mortality rate.
• Mortality decreased significantly from 13.9% (1990-2000) to 8.8% (2000-2014), correlating with increased use of beta-blockers, ACE inhibitors/ARBs, aldosterone antagonists, and reperfusion strategies.

Conclusions:

• The study highlights the significant burden of STEMI in India, with a distinct demographic and risk factor profile.
• Advancements in medical management, including pharmacotherapy and reperfusion strategies, have demonstrably reduced STEMI-related mortality.