Temporal trends in event rates after Q-wave myocardial infarction - The framingham heart study

Background-Short-term (<30 day) mortality after Q-wave myocardial infarctio n (MI) has declined over the decades, but it is unclear if rates of long-te rm 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 initia l 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 th ese 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 subsequ ent decades (1970 through 1979. HR, 0.69; 95% CI, 0.49 to 0.98; 1980 throug h 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 i n the risks for recurrent MI or CHF. Conclusions-Substantial reductions in risk of CHD death and all-cause morta lity occurred over these 4 decades, coincident with improvements in post-MI therapies. The absence of a decline in CHF incidence may be due to improve d post-MI survival of individuals with depressed left ventricular systolic function who are at high risk for CHF.