English summary: The incidence of acute coronary events has declined and the prognosis improved from 1993 through 2007 - results from the FINAMI Study

Background

Coronary heart disease is one of the most important public health problems. However, the clinical picture as well as the diagnostic criteria of acute coronary events have changed, which has complicated the monitoring of acute coronary events. The purpose of the present report is to describe the trends in acute coronary events in the FINAMI study areas from 1993 through 2007.

Methods

FINAMI is a population-based myocardial infarction register which aims to record all coronary events that occur in populations of the four monitored areas. The monitored areas are the town of Turku in southwestern Finland, the town of Oulu in northwestern Finland, the town of Kuopio in eastern Finland and the town of Joensuu and three surrounding rural communities in eastern Finland. During the study period, 24 905 acute coronary events were observed among inhabitants of the study areas aged >35 years.

Results

The age-standardized coronary mortality declined significantly in all study areas. The magnitude of the average annual decline varied among men from 3.3% in North Karelia to 5.1% in Turku, and among women from 3.1% in North Karelia to 6.2% in Kuopio. The incidence of first events also declined, but less than mortality. The 28-day case fatality improved clearly, especially among those who had reached a hospital alive. Mortality was higher in the rural areas of North Karelia than in the town of Joensuu. In particular, the prehospital case fatality was high among men in rural North Karelia.

Conclusions

These results reflect continuous improvements in the prevention and treatment of acute coronary events in Finland. More attention should be paid to reducing the delays in seeking treatment and to administering treatment among males in rural areas.