Trends in acute myocardial infarction mortality and morbidity from 1979 to 2001 in the City of Zagreb, Croatia.

Aim: To define trends in age-adjusted acute myocardial infarction mortality and morbidity in women and men in the city of Zagreb, Croatia, in the period 1979-2001.

Methods: Acute myocardial infarctions occurring in both men and women at ages between 25 and 74 years were analyzed by using 1979-2001 data from the Acute Myocardial Infarction Population-based Register for the City of Zagreb, Croatia. The patients with myocardial infarction were identified retrospectively from the hospital discharge reports and death certificates in Zagreb hospitals and the Croatian Statistical Bureau.

Results: Over the period of 23 years, a total of 25,359 cases of acute myocardial infarction were registered in the city of Zagreb (18,345 men and 7,014 women). The age-adjusted attack rate for men was the lowest in 1981 (170 per 100,000 population) and the highest in 1993 (274 per 100,000 population), with a decreasing trend toward 2001. The rate for women was between 49 per 100,000 population in 1979 and 86 per 100,000 population in 1993, with a decreasing trend afterwards. Between 1993 and 2001, the rate for men decreased by 68.6% and for women by 62.8% (P=0.370). The age-adjusted mortality rate showed more pronounced changes and was much higher for men then for women. The rates per 100,000 population among men varied between 80 and 140, and among women between 20 and 40. Between 1993 and 2001, the age-adjusted myocardial infarction mortality rates decreased by 56.3% and 52.5% in men and women, respectively (P=0.670). The age-adjusted prehospital mortality rate for men was much higher than the hospital mortality rate and had an obvious decreasing trend since 1993. Both rates were much lower for women. Twenty-eight-day case-fatality rate for men ranged from 38.5% to 49.1%, and from 39.0% to 64.0% for women. It did not change much in men during the observed period. Women younger than 45 years had a significantly greater risk of a fatal heart attack, whereas the risk was greater for men in the older age groups (55-74 years).

Conclusion: The age-adjusted attack rates, mortality rates, prehospital death rates, and case-fatality rates showed a definite decline since the early 1990s for both men and women, but the decline was greater for men.