title: Trends in long-term prognosis after acute coronary syndrome.
abstract: Background Coronary heart disease incidence, mortality and short-term case-fatality have improved substantially during the past decades. Recent changes in the long-term prognosis among survivors of acute coronary syndrome are less well known. Our aim was to investigate the long-term prognosis of acute coronary syndrome. Design An observational myocardial infarction register study. Methods Data was derived from the population based Finnish Myocardial Infarction register. Patients aged 35 or higher, who had their first acute coronary syndrome during 1993-2011 and survived the first 28 days, were included in the analysis ( n = 13,336). Endpoints were fatal and non-fatal cardiovascular disease events and all-cause mortality at one year and three years after the index event. We also compared the prognosis of acute coronary syndrome survivors with the prognosis of an apparently healthy population with the same age, sex and area of residence, derived from the FINRISK study. Results Significant declines over time were observed in the risk of a new cardiovascular disease event. At three year follow-up the age- and study area-adjusted hazard ratio per calendar year was 0.969 (95% confidence interval 0.960-0.977, p = 4.63 × 10-13) among men and 0.969 (95% confidence interval 0.961-0.978, p = 1.01 × 10-11) among women. Despite the improvement in prognosis, the age-standardized three year cardiovascular disease free survival of acute coronary syndrome patients was significantly lower than in the FINRISK control group (for men p = 6.64 × 10-27and for women p = 2.11 × 10-15). Conclusion The prognosis of acute coronary syndrome survivors has improved during the 18-year period but is still much worse than the prognosis of comparable general population.
authors.affiliation: 1 Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland.|2 Oulu University Hospital, and University of Oulu, Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Piironen
authors.affiliation: 1 Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland.|2 Oulu University Hospital, and University of Oulu, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Ukkola
authors.affiliation: 1 Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland.|2 Oulu University Hospital, and University of Oulu, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Huikuri
authors.affiliation: 3 Department of Health, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Aki S
authors.initials: AS
authors.lastname: Havulinna
authors.affiliation: 4 University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Koukkunen
authors.affiliation: 5 North Karelia Central Hospital, Joensuu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Mustonen
authors.affiliation: 5 North Karelia Central Hospital, Joensuu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Ketonen
authors.affiliation: 6 University of Eastern Finland, Kuopio, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Lehto
authors.affiliation: 7 Heart Centre, Turku University Hospital, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.affiliation: 1 Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland.|2 Oulu University Hospital, and University of Oulu, Finland.
authors.forename: Y
authors.initials: Y
authors.lastname: Antero Kesäniemi
authors.affiliation: 3 Department of Health, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors
keywords: Coronary artery disease; acute coronary syndrome; epidemiology; myocardial infarction