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The evolving epidemiology of acute coronary syndromes

Nature Reviews Cardiology volume 8, pages 140–147 (2011)Cite this article

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Abstract

The clinical entities that comprise acute coronary syndromes (ACS)—ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina—have been recognized as widespread causes of death and disability for more than a century. Seminal research in the past 50 years has led to important scientific and medical advances in our understanding of ACS. Rapid modernization of the developing world has led to a pandemic of coronary artery disease and its manifestation as ACS, with profound implications for personal, societal, and global health. Epidemiological studies have provided insight into the changing demographics of ACS, and highlighted the importance of modifiable risk factors and adherence to guideline-recommended therapy.

Key Points

  • The prevalence of acute coronary syndromes (ACS) has reached a pandemic level as a consequence of modernization of the developing world

  • The demographics of ACS have evolved, with a precipitous decline in the incidence of ST-segment elevation myocardial infarction (STEMI) and a progressive rise in the incidence of non-STEMI

  • Modifiable risk factors account for >90% of the risk of myocardial infarction

  • Cardiac mortality has declined steadily over the past 50 years

  • Improvement in outcomes after ACS reflects increased adoption and utilization of evidence-based therapies, although racial, ethnic, and socioeconomic differences in care still exist

  • Epidemiological surveillance and population-based studies will be essential to evaluate the successful translation of evidence-based medicine into clinical practice

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Figure 1: Age-adjusted and sex-adjusted incidence of acute MI in Kaiser Permanente, Northern California, USA, from 1999 to 2008.
Figure 2: Prevalence of STEMI and NSTEMI in the National Registry of Myocardial Infarction from 1990 to 2006 and proportion of patients in whom a troponin assay was used to diagnose MI.
Figure 3: Trends in incidence of hospitalized MI from 1987 to 2006 in Olmsted County, MN, USA, by ST-segment elevation status.
Figure 4: Risk of myocardial infarction associated with exposure to various risk factors in the INTERHEART study.
Figure 5: Hospital adherence to guidelines and mortality resulting from acute coronary syndromes in the CRUSADE registry.

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  1. Cardiovascular Division, Department of Medicine, TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, 02115, MA, USA

    Christian T. Ruff & Eugene Braunwald

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C. T. Ruff and E. Braunwald researched data for the article, contributed to discussion of the content, and reviewed and edited the article before submission and after peer review. The article was written by C. T. Ruff.

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Ruff, C., Braunwald, E. The evolving epidemiology of acute coronary syndromes. Nat Rev Cardiol 8, 140–147 (2011). https://doi.org/10.1038/nrcardio.2010.199

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