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(Circulation. 1999;100:2054-2059.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Temporal Trends in Event Rates After Q-Wave Myocardial Infarction

The Framingham Heart Study

Ursula C. Guidry, MD; Jane C. Evans, DSc, MPH; Martin G. Larson, ScD; Peter W. F. Wilson, MD, MPH; Joanne M. Murabito, MD, MPH; Daniel Levy, MD, MPH

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Mass (U.C.G., J.C.E., M.G.L., P.W.F.W., J.M.M., D.L.); National Heart, Lung, and Blood Institute, Bethesda, Md (P.W.F.W., D.L.); Sections of Preventive Medicine (U.C.G., J.C.E., M.G.L., J.M.M., D.L.) and General Internal Medicine (J.M.M.), Boston University School of Medicine, Boston, Mass; and the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Harvard Medical School, Boston, Mass (D.L.)

Correspondence to Dr Daniel Levy, Framingham Heart Study, 5 Thurber St, Framingham, MA 01702.

Background—Short-term (<30 day) mortality after Q-wave myocardial infarction (MI) has declined over the decades, but it is unclear if rates of long-term sequelae after Q-wave MI have improved.

Methods and Results—In 546 Framingham Heart Study subjects (388 men with a mean age of 60 years; 158 women with a mean age of 69 years) with an initial recognized Q-wave MI from 1950 through 1989, we investigated time trends in risk for coronary heart disease (CHD) death (n=199), all-cause mortality (n=287), reinfarction (n=108), and congestive heart failure (CHF; n=121). With 1950 through 1969 as the reference period, hazards ratios (HRs) for these outcomes were determined for the 1970s and 1980s. Trend analyses across the 3 time periods were performed for each outcome. Compared with the 1950 through 1969 reference period, the HRs for CHD death were lower in subsequent decades (1970 through 1979: HR, 0.69; 95% CI, 0.49 to 0.98; 1980 through 1989: HR, 0.48; 95% CI, 0.33 to 0.72). All-cause mortality also declined (1970 through 1979: HR, 0.70; 95% CI, 0.0.52 to 0.94; 1980 through 1989: HR, 0.59; 95% CI, 0.43 to 0.81). There were no significant temporal changes in the risks for recurrent MI or CHF.

Conclusions—Substantial reductions in risk of CHD death and all-cause mortality occurred over these 4 decades, coincident with improvements in post-MI therapies. The absence of a decline in CHF incidence may be due to improved post-MI survival of individuals with depressed left ventricular systolic function who are at high risk for CHF.

Key Words: myocardial infarction • morbidity • mortality • heart failure • epidemiology

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