Gerber Bernhard L, Mande Ines Kyungu, Rizzi Sergio, Brohet Christian, Schröder Erwin, Chenu Patrick, Robert Annie
Division of Cardiology (CARD), Department of Cardiovascular Diseases, and Division of Epidemiology (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
Acta Cardiol. 2025 Sep;80(7):709-720. doi: 10.1080/00015385.2025.2524233. Epub 2025 Jul 17.
We sought to evaluate the temporal changes in the incidence of acute myocardial infarction (AMI) using a 30-year continuation of the WHO MONICA registry in Luxembourg, applying modern MI definitions (STEMI and NSTEMI).
We reanalysed clinical records, biomarkers, ECGs, and angiograms of all suspected Type I and III AMI cases from 1985 to 2014 in the MONICA-BELLUX registry. Cases were classified according to modern criteria as STEMI, NSTEMI, or ischaemic sudden cardiac death. Statistical analyses assessed trends in AMI incidence by sex, age group, and AMI type.
A total of 6,786 AMI cases were identified, including 4,361 STEMI, 1,507 NSTEMI confirmed by coronary thrombosis, 616 suspected NSTEMI, and 394 type III infarcts. The overall AMI incidence decreased by 5.3 events per 100,000 inhabitants annually, from 314 per 100,000 in 1986 to 116 per 100,000 in 2014. This decline was driven mainly by a 3.8-fold reduction in STEMI. NSTEMI incidence initially decreased, then stabilised after 2004, with the STEMI-to-NSTEMI ratio converging by 2009. While women had 3.8 times lower incidence of AMI, trends were similar across both sexes and all age groups. Survival rates, lower in women and NSTEMI, improved with increased use of coronary angiography and revascularization.
Over 30 years, AMI incidence, particularly STEMI, decreased threefold across all age groups and genders, while NSTEMI incidence initially declined but increased after 2000 due to improved diagnostic sensitivity with troponins, and survival rates improved with greater use of angiography and revascularization.
我们试图利用世界卫生组织（WHO）在卢森堡的莫尼卡（MONICA）登记处30年的延续数据，应用现代心肌梗死（MI）定义（ST段抬高型心肌梗死和非ST段抬高型心肌梗死）来评估急性心肌梗死（AMI）发病率的时间变化。
我们重新分析了莫尼卡-卢森堡（MONICA-BELLUX）登记处1985年至2014年所有疑似I型和III型AMI病例的临床记录、生物标志物、心电图和血管造影。病例根据现代标准分为ST段抬高型心肌梗死、非ST段抬高型心肌梗死或缺血性心源性猝死。统计分析评估了按性别、年龄组和AMI类型划分的AMI发病率趋势。
共确定6786例AMI病例，包括4361例ST段抬高型心肌梗死、1507例经冠状动脉血栓形成证实的非ST段抬高型心肌梗死、616例疑似非ST段抬高型心肌梗死和394例III型梗死。总体AMI发病率每年每10万居民减少5.3例，从1986年的每10万例314例降至2014年的每10万例116例。这种下降主要是由ST段抬高型心肌梗死减少3.8倍驱动的。非ST段抬高型心肌梗死发病率最初下降，然后在2004年后稳定下来，到2009年ST段抬高型心肌梗死与非ST段抬高型心肌梗死的比例趋于一致。虽然女性AMI发病率低3.8倍，但男女和所有年龄组的趋势相似。女性和非ST段抬高型心肌梗死患者的生存率较低，随着冠状动脉造影和血运重建的使用增加而有所改善。
在30年期间，所有年龄组和性别的AMI发病率，尤其是ST段抬高型心肌梗死发病率下降了三倍，而非ST段抬高型心肌梗死发病率最初下降，但由于肌钙蛋白诊断敏感性提高，2000年后有所上升，并且随着血管造影和血运重建的更多使用，生存率有所提高。
