Figure 1
Schematic process flowchart highlighting the data management stratagem and study enrolment chart using STROBE guidelines.
Table 1
Validation of categorical variables (30-year dataset); n = 49.
| CATEGORICAL VARIABLES | OBSERVED AGREEMENT (%) | ĸ STATISTIC |
|---|---|---|
| Sex | 97.9% | 0.95 |
| AMI type (STEMI vs NSTEMI) | 97.9% | 0.94 |
| Smoker | 91.8% | 0.80 |
| Diabetes Mellitus | 95.9% | 0.91 |
| Hypertension | 100.0% | 1.00 |
| Dyslipidaemia | 97.9% | 0.93 |
| Coronary Angiography | 95.9% | 0.91 |
| Percutaneous Coronary Intervention | 97.9% | 0.95 |
| Coronary Artery Bypass Graft | 100.0% | 1.00 |
| Acute Kidney Injury | 83.6% | 0.53 |
| Cardiogenic Shock | 97.9% | 0.79 |
| Mortality | 100.0% | 1.00 |
| CONTINUOUS VARIABLES | INTRA-CLASS CORRELATION | 95% CI |
| Age | 0.99 | 0.98–0.99 |
| Length of hospital stay | 0.95 | 0.91–0.97 |
Table 2
Total and decade-wise chronological trends of patient characteristics (n = 14,601).
| 1988–2018 TOTAL n = 14,601 n (%) | 1988–1997 TOTAL n = 2544 n (%) | 1998–2007 TOTAL n = 5102 n (%) | 2008–2018 TOTAL n = 6955 n (%) | Ptrend | |
|---|---|---|---|---|---|
| Age; Median (IQR) | 61 (52–70) | 58 (50–66) | 60 (52–70) | 63 (54–71) | <0.001* |
| Range | 19–101 | 22–94 | 19–96 | 19–101 | |
| Sex | |||||
| Male | 10131 (69.4) | 1859 (73.1) | 3603 (70.6) | 4669 (67.1) | <0.001 |
| Female | 4470 (30.6) | 685 (26.9) | 1499 (29.4) | 2286 (32.9) | |
| STEMI | 7651 (52.4) | 2076 (81.6) | 2714 (53.2) | 2861 (41.1) | <0.001 |
| NSTEMI | 6950 (47.6) | 468 (18.4) | 2388 (46.8) | 4094 (58.9) | |
| RISK FACTORS | |||||
| Current Smoker | 4388 (30.1) | 336 (13.2) | 1842 (36.1) | 2210 (31.8) | <0.001 |
| Diabetes Mellitus | 6985 (47.8) | 962 (37.8) | 2342 (45.9) | 3681 (52.9) | <0.001 |
| Hypertension | 9070 (62.1) | 1108 (43.6) | 3006 (58.9) | 4956 (71.3) | <0.001 |
| Dyslipidaemia | 3594 (24.6) | 284 (11.2) | 2264 (44.4) | 1046 (15.0) | <0.001 |
| PROCEDURES | |||||
| Coronary Angiography | 7382 (50.6) | 110 (4.3) | 2699 (52.9) | 4573 (65.8) | <0.001 |
| Percutaneous Coronary Intervention | 4626 (31.7) | 17 (0.7) | 1366 (26.8) | 3243 (46.6) | <0.001 |
| Coronary Artery Bypass Graft | 1149 (7.9) | 16 (0.6) | 546 (10.7) | 587 (8.4) | <0.001 |
| COMPLICATIONS AND OUTCOMES | |||||
| Acute Kidney Injury | 2295 (15.7) | 78 (3.1) | 347 (6.8) | 1870 (26.9) | <0.001 |
| Cardiogenic Shock | 1206 (8.3) | 142 (5.6) | 373 (7.3) | 691 (9.9) | 0.001 |
| Heart Failure | 4129 (28.3) | 684 (26.9) | 1422 (27.9) | 2023 (29.1) | 0.072 |
| In-hospital Mortality | 1507 (10.3) | 351 (13.8) | 513 (10.1) | 643 (9.2) | <0.001 |
| Length of hospital stay (days); median (IQR) | 4 (3–7) | 6 (4–8) | 5 (3–8) | 3 (2–6) | <0.001* |
[i] * p value of likelihood ratio chi-square test.
Figure 2
Trends in total number of AMI index admissions.
Table 3
Temporal trends of characteristics of STEMI (n = 7,651) and NSTEMI (n = 6,950).
| STEMI (N = 7,651) | ||||
|---|---|---|---|---|
| 1988–1997 TOTAL n = 2076 n (%) | 1998–2007 TOTAL n = 2714 n (%) | 2008–2018 TOTAL n = 2861 n (%) | Ptrend | |
| Age, in years, median (IQR) | 57 (49–65) | 58 (50–66) | 59 (50–68) | <0.001* |
| Range | 22–94 | 25–96 | 19–100 | |
| Sex | ||||
| Male | 1567 (75.5) | 2092 (77.1) | 2134 (74.6) | 0.360 |
| Female | 509 (24.5) | 622 (22.9) | 727 (25.4) | |
| RISK FACTORS | ||||
| Current Smoker | 241 (11.6) | 1086 (40.0) | 1031 (36.0) | <0.001 |
| Diabetes Mellitus | 759 (36.6) | 1090 (40.2) | 1250 (43.7) | <0.001 |
| Hypertension | 851 (41.0) | 1386 (51.1) | 1735 (60.6) | <0.001 |
| Dyslipidaemia | 201 (9.7) | 1192 (43.9) | 412 (14.4) | 0.383 |
| PROCEDURES | ||||
| Coronary Angiography | 77 (3.7) | 1626 (59.9) | 2477 (86.6) | <0.001 |
| Percutaneous Coronary Intervention | 12 (0.6) | 961 (35.4) | 2088 (73.0) | <0.001 |
| Coronary Artery Bypass Graft | 12 (0.6) | 267 (9.8) | 223 (7.8) | <0.001 |
| COMPLICATIONS AND OUTCOMES | ||||
| Acute Kidney Injury | 65 (3.1) | 148 (5.5) | 508 (17.8) | <0.001 |
| Cardiogenic Shock | 130 (6.3) | 287 (10.6) | 462 (16.1) | <0.001 |
| Heart Failure | 530 (25.5) | 523 (19.3) | 495 (17.3) | <0.001 |
| In-hospital Mortality | 314 (15.1) | 334 (12.3) | 331 (11.6) | <0.001 |
| Length of hospital stay (days); median (IQR) | 6 (4–8) | 4 (3–7) | 3 (2–5) | <0.001* |
| NSTEMI (N = 6,950) | ||||
| 1988–1997 TOTAL n = 468 n (%) | 1998–2007 TOTAL n = 2388 n (%) | 2008–2018 TOTAL n = 4094 n (%) | Ptrend | |
| Age; in years, median (IQR) | 61 (53–69) | 64 (55–72) | 65 (57–74) | <0.001* |
| Range | 25–90 | 20–96 | 19–101 | |
| Sex | ||||
| Male | 292 (62.4) | 1511 (63.3) | 2535 (61.9) | 0.418 |
| Female | 176 (37.6) | 877 (36.7) | 1559 (38.1) | |
| RISK FACTORS | ||||
| Current Smoker | 95 (20.3) | 756 (31.7) | 1179 (28.8) | 0.289 |
| Diabetes Mellitus | 203 (43.4) | 1252 (52.4) | 2431 (59.4) | <0.001 |
| Hypertension | 257 (54.9) | 1620 (67.8) | 3221 (78.7) | <0.001 |
| Dyslipidaemia | 83 (17.7) | 1072 (44.9) | 634 (15.5) | <0.001 |
| PROCEDURES | ||||
| Coronary Angiography | 33 (7.1) | 1073 (44.9) | 2096 (51.2) | <0.001 |
| Percutaneous Coronary Intervention | 5 (1.1) | 405 (17.0) | 1155 (28.2) | <0.001 |
| Coronary Artery Bypass Graft | 4 (0.9) | 279 (11.7) | 364 (8.9) | 0.130 |
| COMPLICATIONS AND OUTCOMES | ||||
| Acute Kidney Injury | 13 (2.8) | 199 (8.3) | 1362 (33.3) | <0.001 |
| Cardiogenic Shock | 12 (2.6) | 86 (3.6) | 229 (5.6) | <0.001 |
| Heart Failure | 154 (32.9) | 899 (37.6) | 1528 (37.3) | <0.001 |
| In-hospital Mortality | 37 (7.9) | 179 (7.5) | 312 (7.6) | 0.973 |
| Length of hospital stay (days); median (IQR) | 6 (4–8) | 5 (3–8) | 3 (2–6) | <0.001* |
[i] * p value of likelihood ratio chi-square test.
Figure 3
Trends in proportions of STEMI and NSTEMI.
Figure 4
Chronological trends of AMI mortality over three decades.