Abstract
BACKGROUND: The study explores the enduring challenges of cardiovascular disease mortality, emphasizing myocardial infarction rates as a proxy for cardiovascular disease in Iran. It analyzes the 28-day mortality trends after Acute Myocardial Infarction (AMI) from 2000 to 2017. METHODS: This retrospective cohort study is based on data from a multi-centric hospital-based registry in Isfahan. Univariate and multivariate frailty Cox regression analyses were performed to identify Hazard Ratios (HRs) for the 28-day mortality rate of AMI based on age, gender, and living region. RESULTS: The study enrolled 121,284 patients with an average age of 62.00±12.82 years. Older age than 65 years was found to be associated with an increased risk of AMI (HR: 3.2, 95% CI: 2.7-3.8 from 2000 to 2002 and HR: 4.6, 95% CI: 3.7-5.7 for 2015-2017). There was also an association between living in the urban region and a decreased risk of AMI from 2000 to 2005 (HR: 0.64, 95% CI: 0.46-0.90), from 2000 to 2002 (HR: 0.55, 95% CI: 0.43-0.71 for 2003-2005). Results showed that the trend of change in 28-day mortality declined more significantly from 2006 to 2017 compared to 2000-2002. Younger age (61.76±12.69 vs 71.12±11.73), female gender (HR:0.77, 95%CI: 0.67,0.89), and living in urban regions (HR: 0.69, 95%CI: (0.52,0.94) were the protective factors for the 28-days mortality rate of AMI. CONCLUSION: It can be concluded that 28-day mortality had a descending trend from 2006 to 2017. Older age, male gender, and living in a rural region were the risk factors that affected the 28-day mortality rate of AMI.