European Journal of Preventive Cardiology http://cpr.sagepub.com/
Association of age and gender with risk for non-ST-elevation myocardial infarction Ville Kytö, Jussi Sipilä and Päivi Rautava European Journal of Preventive Cardiology published online 9 June 2014 DOI: 10.1177/2047487314539434 The online version of this article can be found at: http://cpr.sagepub.com/content/early/2014/06/06/2047487314539434
Published by: http://www.sagepublications.com
On behalf of: European Society of Cardiology
European Association for Cardiovascular Prevention and Rehabilitation
Additional services and information for European Journal of Preventive Cardiology can be found at: Email Alerts: http://cpr.sagepub.com/cgi/alerts Subscriptions: http://cpr.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
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[1–6] [PREPRINTER stage]
EURO PEAN SO CIETY O F CARDIOLOGY ®
Original scientific paper
Association of age and gender with risk for non-ST-elevation myocardial infarction Ville Kyto¨1,2, Jussi Sipila¨3,4 and Pa¨ivi Rautava5,6
European Journal of Preventive Cardiology 0(00) 1–6 ! The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487314539434 ejpc.sagepub.com
Abstract Background: Age and gender associated risks for non-ST-elevation myocardial infarction (NSTEMI) at the population level are largely uncharacterized. Design: Nationwide, population (26,724,165 person-years) based eight-year registry-study in Finland. Methods: Gender- and age-associated frequency and incidence of NSTEMI were studied using a nationwide, population based registry of hospital admissions in patients aged 30 years during 2001–2008. Patients with NSTEMI as primary (88%), secondary (10%) or tertiary (2%) discharge diagnosis were included. Data was collected nationwide from all 22 hospitals with a coronary angiolaboratory. Results: The study period included 48,584 NSTEMI admissions of which 55.3% (95% confidence interval (CI) 54.6–56.0%) were of men and 44.7% (CI 44.1–45.3%) were of women, with age-adjusted relative risk of 1.86 (CI 1.60–2.16, p < 0.0001) for male gender. Female patients were significantly older than males (77.8 SD 10.2 vs. 70.2 SD 11.9 years, p < 0.0001). Standardized incidence rate of NSTEMI was 20.6 (CI 20.4–20.8)/10,000 person-years overall, 28.7 (CI 28.3–29.0)/10,000 in men and 15.0 (CI 14.7–15.2)/10,000 in women. Men had a 2.36-fold (CI 2.23–2.49; p < 0.0001) age-adjusted relative risk for NSTEMI compared with women, with highest risk difference in population under 40 years of age (relative risk 4.48; CI 3.10–6.48, p < 0.0001). Incidence increased with age by an estimated genderadjusted increase rate of 61% (CI 59–62%; p < 0.0001) per five-year increase in age. Conclusions: Men have a 2.4-fold overall risk for NSTEMI compared with women, with highest relative risk in young adults. Incidence rate of non-ST-elevation myocardial infarction increases by an estimated 61% per five-year increase in age.
Keywords Myocardial infarction, coronary artery disease, incidence, occurrence, age distribution, sex distribution Received 8 April 2014; accepted 22 May 2014
Introduction Myocardial infarction is classified based on electrocardiographical presentation as ST-elevation or non-ST-elevation myocardial infarction (NSTEMI). Although developing effective primary percutaneous coronary intervention networks for treatment of STelevation myocardial infarction has been the particular focus of the cardiological community in recent years,1,2 the majority of patients with myocardial infarction have NSTEMI.3 Recent studies have reported on general epidemiology of all myocardial infarctions4–14 as well as NSTEMI.15–24 Men are uniformly reported as having a higher risk for myocardial infarction than women, and risk for infarction has a general trend of increase with age. However, exact gender- and ageassociated risks for NSTEMI at the population level
are less well known. In order to clarify age- and gender-associated risks for NSTEMI, we studied the occurrence of NSTEMI in the general population using a nationwide multihospital cohort. 1
Heart Centre, Turku University Hospital, Finland PET Centre, University of Turku, Finland 3 Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital, Finland 4 Department of Neurology, University of Turku, Finland 5 Clinical Research Centre, Turku University Hospital, Finland 6 Public Health, University of Turku, Finland 2
Corresponding author: Ville Kyto¨, Heart Centre, Turku University Hospital, POB 52, FI-20521 Turku, Finland. Email: [email protected]
Downloaded from cpr.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 5, 2014
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Figure 1. Number of non-ST-elevation myocardial infarction (NSTEMI) admissions. Age-distribution of all NSTEMI patients (a) and by gender (from total number of patients) (b). Error bars represent upper limits of 95% confidence intervals.
Methods Study patients and data collection
Statistical analysis Effects of age, gender and study year on frequency and incidence were analysed with a negative binomial regression model (data overdispersion in a Poisson model). Age of patients was analysed with negative binomial regression adjusted for study year and
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Age (years)
We included all patients aged 30 years with NSTEMI as primary (87.7% of patients), secondary (9.7% of patients) or tertiary (2.6% of patients) discharge diagnosis (ICD-10 codes I21.4 or I21.9). Study data was retrospectively collected from the Finnish Hospital Discharge Register, a nationwide database maintained by the Finnish National Institute for Health and Welfare that contains hospital discharge diagnosis codes of all medical admissions in Finland. All 22 Finnish hospitals that treat emergency coronary patients and have a coronary catheterization laboratory were included. Admissions originating between 1 January 2001 and 31 December 2008 were included. Hospital transfers (3.6% of admissions) occurring during the same treatment period were combined. The study population was mainly Caucasians. Ageand gender-matched population data of mainland Finland from the same period was acquired from the Statistics Finland database (26,724,165 person-years). The study was approved by the National Institute for Health and Welfare (permission no. THL/1576/5.05.00/ 2010).
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Figure 2. Age-specific likelihood for male gender of a non-ST-elevation myocardial infarction (NSTEMI) patient. Likelihood ratio is adjusted for study year. Error bars represent 95% confidence intervals.
gender as appropriate. Incidence calculations were standardized by direct method using the European 2013 standard population. Scale variables are presented as mean with SD or median with interquartile range as appropriate. Categorical variables are presented as counts, percentages or relative risks (RRs) with 95% confidence intervals (CIs) as appropriate. Confidence intervals were calculated assuming Poisson distribution. p-values
Association of age and gender with risk for non-ST-elevation myocardial infarction Ville Kytö, Jussi Sipilä and Päivi Rautava European Journal of Preventive Cardiology published online 9 June 2014 DOI: 10.1177/2047487314539434 The online version of this article can be found at: http://cpr.sagepub.com/content/early/2014/06/06/2047487314539434
Published by: http://www.sagepublications.com
On behalf of: European Society of Cardiology
European Association for Cardiovascular Prevention and Rehabilitation
Additional services and information for European Journal of Preventive Cardiology can be found at: Email Alerts: http://cpr.sagepub.com/cgi/alerts Subscriptions: http://cpr.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Jun 9, 2014 What is This?
Downloaded from cpr.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 5, 2014
XML Template (2014) [5.6.2014–12:33pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/CPRJ/Vol00000/140080/APPFile/SG-CPRJ140080.3d
(CPR)
[1–6] [PREPRINTER stage]
EURO PEAN SO CIETY O F CARDIOLOGY ®
Original scientific paper
Association of age and gender with risk for non-ST-elevation myocardial infarction Ville Kyto¨1,2, Jussi Sipila¨3,4 and Pa¨ivi Rautava5,6
European Journal of Preventive Cardiology 0(00) 1–6 ! The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487314539434 ejpc.sagepub.com
Abstract Background: Age and gender associated risks for non-ST-elevation myocardial infarction (NSTEMI) at the population level are largely uncharacterized. Design: Nationwide, population (26,724,165 person-years) based eight-year registry-study in Finland. Methods: Gender- and age-associated frequency and incidence of NSTEMI were studied using a nationwide, population based registry of hospital admissions in patients aged 30 years during 2001–2008. Patients with NSTEMI as primary (88%), secondary (10%) or tertiary (2%) discharge diagnosis were included. Data was collected nationwide from all 22 hospitals with a coronary angiolaboratory. Results: The study period included 48,584 NSTEMI admissions of which 55.3% (95% confidence interval (CI) 54.6–56.0%) were of men and 44.7% (CI 44.1–45.3%) were of women, with age-adjusted relative risk of 1.86 (CI 1.60–2.16, p < 0.0001) for male gender. Female patients were significantly older than males (77.8 SD 10.2 vs. 70.2 SD 11.9 years, p < 0.0001). Standardized incidence rate of NSTEMI was 20.6 (CI 20.4–20.8)/10,000 person-years overall, 28.7 (CI 28.3–29.0)/10,000 in men and 15.0 (CI 14.7–15.2)/10,000 in women. Men had a 2.36-fold (CI 2.23–2.49; p < 0.0001) age-adjusted relative risk for NSTEMI compared with women, with highest risk difference in population under 40 years of age (relative risk 4.48; CI 3.10–6.48, p < 0.0001). Incidence increased with age by an estimated genderadjusted increase rate of 61% (CI 59–62%; p < 0.0001) per five-year increase in age. Conclusions: Men have a 2.4-fold overall risk for NSTEMI compared with women, with highest relative risk in young adults. Incidence rate of non-ST-elevation myocardial infarction increases by an estimated 61% per five-year increase in age.
Keywords Myocardial infarction, coronary artery disease, incidence, occurrence, age distribution, sex distribution Received 8 April 2014; accepted 22 May 2014
Introduction Myocardial infarction is classified based on electrocardiographical presentation as ST-elevation or non-ST-elevation myocardial infarction (NSTEMI). Although developing effective primary percutaneous coronary intervention networks for treatment of STelevation myocardial infarction has been the particular focus of the cardiological community in recent years,1,2 the majority of patients with myocardial infarction have NSTEMI.3 Recent studies have reported on general epidemiology of all myocardial infarctions4–14 as well as NSTEMI.15–24 Men are uniformly reported as having a higher risk for myocardial infarction than women, and risk for infarction has a general trend of increase with age. However, exact gender- and ageassociated risks for NSTEMI at the population level
are less well known. In order to clarify age- and gender-associated risks for NSTEMI, we studied the occurrence of NSTEMI in the general population using a nationwide multihospital cohort. 1
Heart Centre, Turku University Hospital, Finland PET Centre, University of Turku, Finland 3 Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital, Finland 4 Department of Neurology, University of Turku, Finland 5 Clinical Research Centre, Turku University Hospital, Finland 6 Public Health, University of Turku, Finland 2
Corresponding author: Ville Kyto¨, Heart Centre, Turku University Hospital, POB 52, FI-20521 Turku, Finland. Email: [email protected]
Downloaded from cpr.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 5, 2014
XML Template (2014) [5.6.2014–12:33pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/CPRJ/Vol00000/140080/APPFile/SG-CPRJ140080.3d
[1–6] [PREPRINTER stage]
(CPR)
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European Journal of Preventive Cardiology 0(00)
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NSTEMI patients (%)
NSTEMI patients (%)
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Figure 1. Number of non-ST-elevation myocardial infarction (NSTEMI) admissions. Age-distribution of all NSTEMI patients (a) and by gender (from total number of patients) (b). Error bars represent upper limits of 95% confidence intervals.
Methods Study patients and data collection
Statistical analysis Effects of age, gender and study year on frequency and incidence were analysed with a negative binomial regression model (data overdispersion in a Poisson model). Age of patients was analysed with negative binomial regression adjusted for study year and
40 - 49 50 - 59
Age (years)
We included all patients aged 30 years with NSTEMI as primary (87.7% of patients), secondary (9.7% of patients) or tertiary (2.6% of patients) discharge diagnosis (ICD-10 codes I21.4 or I21.9). Study data was retrospectively collected from the Finnish Hospital Discharge Register, a nationwide database maintained by the Finnish National Institute for Health and Welfare that contains hospital discharge diagnosis codes of all medical admissions in Finland. All 22 Finnish hospitals that treat emergency coronary patients and have a coronary catheterization laboratory were included. Admissions originating between 1 January 2001 and 31 December 2008 were included. Hospital transfers (3.6% of admissions) occurring during the same treatment period were combined. The study population was mainly Caucasians. Ageand gender-matched population data of mainland Finland from the same period was acquired from the Statistics Finland database (26,724,165 person-years). The study was approved by the National Institute for Health and Welfare (permission no. THL/1576/5.05.00/ 2010).
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60 - 69 70 - 79 80 - 89 90 - 103
Total
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Risk ratio (men vs. women)
Figure 2. Age-specific likelihood for male gender of a non-ST-elevation myocardial infarction (NSTEMI) patient. Likelihood ratio is adjusted for study year. Error bars represent 95% confidence intervals.
gender as appropriate. Incidence calculations were standardized by direct method using the European 2013 standard population. Scale variables are presented as mean with SD or median with interquartile range as appropriate. Categorical variables are presented as counts, percentages or relative risks (RRs) with 95% confidence intervals (CIs) as appropriate. Confidence intervals were calculated assuming Poisson distribution. p-values
