Temporal trend in epidemiology and performance indicators of acute myocardial infarction: A 25 years population-based...

We examined 25-year population-level trends in acute myocardial infarction (AMI) in the Veneto Region (Northeastern Italy), assessing changes in incidence, patient characteristics, management strategies, and outcomes to evaluate the performance and evolution of the regional healthcare system.

We conducted a retrospective population-based analysis of Veneto hospital discharge records (2000-2024), classifying AMI as ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) using ICD-9-CM codes. Key outcomes included same-day percutaneous coronary intervention (PCI), cardiac intensive care unit (CICU) and cardiology unit admission, and 30-day case-fatality, with analyses stratified by age and sex. Age-adjusted temporal trends were assessed using Joinpoint regression and reported as average annual percentage change (AAPC) with 95% confidence intervals.

During the study period, 167,277 patients were hospitalized for AMI: 57.3% STEMI and 42.7% NSTEMI. Age-standardized AMI hospitalizations declined overall [AAPC -2.30%], driven by marked reductions in STEMI [AAPC -4.72%], whereas NSTEMI increased [AAPC +1.05%] and became the predominant phenotype after 2016. Thirty-day mortality decreased for both STEMI [AAPC -1.60%] and NSTEMI [AAPC -1.63%], with age-adjusted sex gaps substantially narrowing. Same-day PCI increased markedly over time [AAPC +6.41%], as did CICU admission [STEMI AAPC +0.85%; NSTEMI AAPC +0.27%], although women consistently underwent PCI less often.

Over 25 years, AMI in the Veneto Region shifted from STEMI to NSTEMI Predominance, with greater invasive care access and lower mortality, though sex disparities persisted, highlighting the need for targeted interventions.