title: Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations.
abstract: OBJECTIVE
  Due to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and mortality rates, and in 28-day case-fatality, in six European populations during 1985-2010.
  
  
  METHODS
  Data consisted of 78 128 AMI events included in eight population-based registries from Finland (several populations), Italy (Brianza and Varese), Germany (Augsburg), France (Haute-Garonne), Spain (Girona) and Estonia (Tallinn). AMI event rates and case-fatality trends were analysed using the annual percentage change (APC) obtained by negative binomial and joinpoint regression.
  
  
  RESULTS
  AMI attack and mortality rates decreased in most populations. Finland experienced the steepest decline in attack rates (APC=-4.4% (95% CI -5.1 to -2.9) in men; -4.0% (-5.1 to -2.8), in women). Total-hospital and inhospital case-fatality decreased in all populations except in Tallinn. The steepest decline in total case-fatality occurred in Spain (-3.8% (-5.3 to -2.4) in men; -5.1% (-6.9 to -3.3) in women). Prehospital case-fatality trends differed significantly by population and sex. The trends for all included populations showed a significant decline in AMI event rates and case-fatality, in both sexes and all age groups. However, in women aged 65-74 years, a significant increase in total case-fatality occurred in 2005-2010 (4.7% (0.7 to 8.8)).
  
  
  CONCLUSIONS
  AMI event rates and inhospital case-fatality declined in 1985-2010 in almost all populations analysed. Prehospital case-fatality declined only in certain population groups, showing differences by sex. These results highlight the need of specific strategies in AMI prevention for certain groups and populations.
authors: Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors: Irene R
authors: IR
authors: Dégano
authors: Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland.
authors: Veikko
authors: V
authors: Salomaa
authors: Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.
authors: Giovanni
authors: http://orcid.org/0000-0002-4119-6615
authors: G
authors: Veronesi
authors: Department of Cardiology, Toulouse University School of Medicine-Rangueil Hospital, Toulouse, France.
authors: Jean
authors: J
authors: Ferriéres
authors: MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany.
authors: Inge
authors: I
authors: Kirchberger
authors: Department of Internal Medicine, North Estonia Medical Centre, Tallinn, Estonia Institute of Cardiovascular Medicine, Tallinn University of Technology, Tallinn, Estonia.
authors: Toivo
authors: T
authors: Laks
authors: Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland.
authors: Aki S
authors: AS
authors: Havulinna
authors: Department of Epidemiology, Toulouse University School of Medicine, Toulouse, France.
authors: Jean-Bernard
authors: JB
authors: Ruidavets
authors: Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.
authors: Marco M
authors: MM
authors: Ferrario
authors: MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany.
authors: Christa
authors: C
authors: Meisinger
authors: Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors: Roberto
authors: R
authors: Elosua
authors: Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors: Jaume
authors: J
authors: Marrugat
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors