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Mild myocardial infarction--a classification problem in epidemiologic studies. WHO MONICA Project
V Salomaa1, A Dobson, H Miettinen
1Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Journal of Clinical Epidemiology
|January 1, 1997
Summary
This study proposes a new definition for milder myocardial infarctions (MI) to better track coronary event trends. The "non-fatal probable MI" category improves the assessment of milder heart attacks in epidemiological studies.
Area of Science:
- Cardiovascular Epidemiology
- Public Health Surveillance
Background:
- Traditional studies on coronary events focus on fatal events and definite myocardial infarctions (MI).
- Milder forms of MI may be increasing due to improved treatments and reduced risk factors.
- Accurate assessment of milder MIs is crucial for understanding cardiovascular disease trends.
Purpose of the Study:
- To investigate definitions for mild non-fatal myocardial infarctions (MI).
- To assess the applicability of these definitions in various settings for tracking milder coronary events.
- To propose a refined category for milder MIs within the WHO MONICA Project framework.
Main Methods:
- Utilized myocardial infarction (MI) register data from the World Health Organization (WHO) MONICA Project.
- Evaluated subsets of milder MI cases across 38 participating populations.
- Proposed dividing the "non-fatal possible MI" category into "non-fatal probable MI" and "prolonged chest pain" based on clinical criteria.
Main Results:
- Over half of the participating centers could identify milder MI cases.
- The proposed "non-fatal probable MI" category showed less variation between populations compared to "non-fatal possible MI".
- Rates of "non-fatal probable MI" correlated more strongly with fatal events and definite MIs, supporting its validity.
- Inclusion of "non-fatal probable MI" revealed larger increases in event rates and decreases in case-fatality for women than men.
Conclusions:
- The proposed "non-fatal probable MI" category is a valid and useful tool for assessing trends in milder myocardial infarctions.
- This refined classification enhances the accuracy of cardiovascular event surveillance in epidemiological studies like the WHO MONICA Project.
- The findings highlight the importance of including milder events for a comprehensive understanding of cardiovascular disease epidemiology, with notable sex-based differences.