title: Acute coronary syndromes in the community.
abstract: OBJECTIVE
  To measure the incidence of acute coronary syndrome (ACS), defined as first-ever myocardial infarction (MI) or unstable angina (UA); evaluate recent temporal trends; and determine whether survival after ACS has changed over time and differs by type.
  
  
  METHODS
  This was a population surveillance study conducted in Olmsted County, Minnesota (population: 144,248). All persons hospitalized with incident ACS between January 1, 2005, and December 31, 2010, were identified using International Classification of Diseases, Ninth Revision codes, natural language processing of the medical records, and biomarkers. Myocardial infarction was validated by epidemiologic criteria and UA by the Braunwald classification. Patients were followed through June 30, 2013, for death.
  
  
  RESULTS
  Of 1244 incident ACS cases, 35% (n=438) were UA and 65% (n=806) were MI. The standardized rates (per 100,000) of ACS were 284 (95% CI, 248-319) in 2005 and 184 (95% CI, 157-210) in 2010 (2010 vs 2005: rate ratio, 0.62; 95% CI, 0.53-0.73), indicating a 38% decline (similar for MI and UA). The 30-day case fatality rates did not differ by year of diagnosis but were worse for MI (8.9%; 95% CI, 6.9%-10.9%) compared with UA (1.9%; 95% CI, 0.6%-3.1%). Among 30-day survivors, the risk of death did not differ by ACS type or diagnosis year.
  
  
  CONCLUSIONS
  In the community, UA constitutes 35% of ACS. The incidence of ACS has declined in recent years, and trends were similar for UA and MI, reaffirming a substantial decline in all acute manifestations of coronary disease. Survival after ACS did not change over time, but 30-day survival was worse for MI compared with UA.
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Sheila M
authors: SM
authors: Manemann
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Yariv
authors: Y
authors: Gerber
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Alanna M
authors: AM
authors: Chamberlain
authors: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Shannon M
authors: SM
authors: Dunlay
authors: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Malcolm R
authors: MR
authors: Bell
authors: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Allan S
authors: AS
authors: Jaffe
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Susan A
authors: SA
authors: Weston
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Jill M
authors: JM
authors: Killian
authors: Department of Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors: Jan
authors: J
authors: Kors
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: roger.veronique@mayo.edu.
authors: Véronique L
authors: VL
authors: Roger
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011159:Population Surveillance; D015996:Survival Rate; D013997:Time Factors