Trends in incidence, attack rate, and mortality of acute myocardial infarction in Estonia: the Tallinn AMI Registry 1991-2005.

OBJECTIVES: Coronary event rates have declined in most Western countries during the past decades, but the trends in the former Eastern block have not been established. The purpose of the present study was to examine the trends in acute coronary events during 1991-2005 in Tallinn, Estonia. DESIGN: The Tallinn Acute Myocardial Infarction (AMI) Registry recorded all AMI events among the residents of Tallinn, Estonia, aged 35-64 years during two time periods, 1991-1997 and 2003-2005. RESULTS: Altogether, 4889 AMI events were recorded. The average age-standardized incidence and attack rate of AMI events were lower in the second than in the first registration period in both sexes. When analyzed annually, the AMI event rates increased from 1991 to 1993 in both sexes. Thereafter from 1993 to 2005 the incidence of first AMI events declined significantly, 2.7%/year in men and 5.0%/year in women (P < 0.001 for both). Also the other event types, except the attack rate among men, tended to decline after 1993. CONCLUSIONS: The year 1993 denoted a significant turning-point in the trends in AMI events in Tallinn, Estonia. After that especially the incidence of first AMI started to decline, and the declines have continued until 2005.

The breakdown of fractal heart rate dynamics predicts prolonged postoperative myocardial ischemia.

UNLABELLED: Patients with myocardial ischemia after noncardiac surgery have a three- to ninefold increased risk of adverse cardiac events. In this study we tested the hypothesis that altered preoperative heart rate variability (HRV) predicts postoperative prolonged myocardial ischemia (>10 min) in elderly surgical patients. Thirty-two patients, age 60 yr or older, admitted to hospital for surgical repair of a traumatic hip fracture with preoperative night and daytime Holter recordings were included. Holter monitoring was initiated at arrival at hospital and continued until the third postoperative morning. Conventional HRV measures along with analysis of short-term fractal scaling exponent (alpha(1)) of RR intervals were assessed for night (from 2 AM to 5 AM) and day (7 AM to 12 AM) periods in each patient. Preoperative alpha(1) was significantly lower (i.e., increased randomness in HRV) during the nighttime compared with daytime (mean +/- SEM; 0.92 +/- 0.08 versus 1.03 +/- 0.06; P = 0.002) in patients with postoperative myocardial ischemia. Patients without ischemia had no such difference. In stepwise multivariate logistic regression analysis, increased preoperative night-day difference of alpha(1) was the only independent predictor of postoperative prolonged ischemia. The odds ratio for an increase of 0.16 U in night-day difference of alpha(1) (corresponding to interquartile range) was 7.7 (95% confidence interval, 1.9-51.4; P = 0.0018). Breakdown of fractal-like heart rate dynamics is predictive for postoperative prolonged myocardial ischemia in elderly patients having emergency surgery for traumatic hip fracture. IMPLICATIONS: Night and daytime Holter recordings before surgical repair of traumatic hip fracture were analyzed with linear and nonlinear heart rate variability methods. Preoperatively increased randomness in heart rate variability was predictive for postoperative, silent prolonged myocardial ischemia. Prolonged myocardial ischemia increases the risk for adverse cardiac events.