STEMI mortality is on the decline, but certain patients still face an above-average risk
A person's risk of death after ST-elevation myocardial infarction (STEMI) may be influenced by their age or even where they live, according to new data published in the American Journal of Cardiology.
While STEMI–related mortality has been declining within the United States in recent years, researchers set out to examine demographic and regional disparities in death rates related to STEMI.
The authors explored CDC data from 1999 to 2019. During that time, they found, there were 3,655,274 deaths attributed to STEMI. A total of 39.4% of those deaths occurred outside of medical facilities, 13.8% occurred in nursing home/long-term care facilities, 0.9% occurred in hospitals, and 24.7% occurred at home.
Overall, age-adjusted mortality rates (AAMRs) declined from 134.7 in 1999 to 48.5 in 2019 with an annual percentage change (AAPC) of −5.0.
The authors found that in men, the AAMR decreased from 176.4 in 1999 to 65.4 in 2019, with an AAPC of −4.8, while in women, the AAMR dropped from 104.4 in 1999 to 34.6 in 2019 with an AAPC of −5.4.
Another key finding from the team’s analysis was that non-Hispanic (NH) Black patients had the highest AAMR, which dropped from 162.4 in 1999 to 58.5 in 2019 with an AAPC of −5.0.
After NH Black patients, NH white patients had the second highest AAMR, which decreased from 134.7 in 1999 to 50.1 in 2019 with an AAPC of −4.9.
In addition, patients older than 85 years had the highest crude mortality rate, which decreased from 1,575.7 to 492.1 from 1999 to 2019 with a noticeable reduction in mortality at an AAPC of −5.7.
Likewise, all other age groups saw decreases in mortality, but those aged 25 to 39 and 40 to 54 years had the smallest reductions in mortality with AAPCs of −2.5 and −2.7, respectively, throughout the study period.
The authors also noted that the average AAMRs were higher in rural counties (113.6) than in urban, large metropolitan counties (71.1) and medium/small metropolitan counties (79.6). Meanwhile, STEMI-related deaths did decline in all three areas over the course of the study.
In addition, average AAMRs were found to be the highest in southern states.
“The geographical results of this study emphasize the heterogeneity of STEMI-related mortality and targeted opportunities for prevention efforts on both the regional and state levels,” wrote lead author Robert W. Ariss, BS, with the division of cardiovascular medicine at the University of Toledo Medical Center, and colleagues. “The reported results are consistent with previous research, which demonstrated paralleled geographic variation in heart failure and stroke mortality within the southern 'stroke belt' states.”
Ariss et al. emphasized that disparities in mortality need to be examined further to minimize STEMI-related deaths in all population groups equitably.
Read the full study here.