Cardiovascular disease (CVD) is a leading cause of illness and death globally, accounting for approximately 31% of all deaths [1]. Ischemic heart disease (IHD), including acute myocardial infarction (AMI), is the primary contributor to these fatalities with the prevalence continuing to rise [2]. Regarding the global scale, depending on the year, AMI affects approximately 15.9 million individuals each year [3], with more than 3 million classified as ST-segment elevation myocardial infarction (STEMI) [4]. However, in Europe, mortality rates from IHD have shown a declining trend over the past three decades. Currently, it accounts for approximately 1.8 million deaths annually, representing 20% of all fatalities across the continent, though significant variations exist between countries [2]. More precisely, the incidence of STEMI has been decreasing, while non ST-segment elevation myocardial infarction (NSTEMI) cases have been on the rise [2].
According to ESC Guidance 2017, Sweden has one of the most comprehensive STEMI registries in Europe, reporting an incidence rate of 58 per 100,000 per year in 2015. Across other European nations, rates vary between 43 and 144 per 100,000 annually. Specifically, in Italy, the incidence of the condition was documented in a 2010 paper, and, as also cited in the 2017 ESC Guidance, was found to be 116 per 100,000 [2, 5]. Similarly, in the United States, the adjusted incidence of STEMI declined from 133 per 100,000 in 1999 to 50 per 100,000 in 2008, while NSTEMI rates remained stable or showed a slight increase [2, 5].
In Friuli Venezia Giulia, an autonomous region in northeastern Italy, CVD rates are generally comparable to the national average in Italy, though certain regional variations exist due to lifestyle factors, healthcare access, and demographic differences. Like the rest of Italy, risk factors such as smoking, physical inactivity, and obesity contribute to the prevalence of CVD in this region. However, studies indicate that Friuli Venezia Giulia has a slightly higher prevalence of certain CVD risk factors compared to other Italian regions, such as a higher proportion of smokers and individuals with hypertension. However, when compared to Europe, Italy, including Friuli Venezia Giulia, benefits from a lower overall incidence of CVD, primarily due to the Mediterranean diet, but lifestyle-related risks remain significant. Regarding the incidence of STEMI across Italy, national data is limited, though regional studies offer useful insights. For example, in the Veneto Region, a study conducted between 2007 and 2016 identified 36,035 STEMI cases, which made up 55.2% of all acute myocardial infarction (AMI) hospitalizations in that period [6]. Over the decade, the incidence of STEMI declined from 111.5 cases per 100,000 population in 2007 to 72.7 per 100,000 in 2016, attributed to better primary prevention and enhanced evidence-based therapies. Additionally, the VENERE 2 registry, conducted from October 2014 to March 2015, recorded 1,165 STEMI patients, resulting in an incidence rate of 657 per million inhabitants annually [7].
Finally, the worldwide occurrence of out-of-hospital cardiac arrest (OHCA) in adults is estimated to be around 95.9 cases per 100,000 individuals annually [8]. While the exact rate can vary by region and population, this estimate underscores the critical need for rapid emergency medical response and timely interventions like cardiopulmonary resuscitation (CPR) [8]. The 2021 European Resuscitation Council Guidelines report that the annual incidence of OHCA in Europe ranges from 67 to 170 cases per 100,000 people [9-12]. Of these, about 50-60% receive CPR, and only 5-18% achieve Return Of Spontaneous Circulation (ROSC) and reach the hospital alive [9-12]. The survival rate to hospital discharge is approximately 8%, with a range between 0% and 18% [9-13]. Of note, the EuReCa TWO study, which spans 27 European countries, revealed notable differences in OHCA incidence, characteristics, and outcomes, though it did not specifically report STEMI prevalence among OHCA cases in Europe [11].
Regarding the prevalence of OHCA in Italy, a systematic review encompassing 42 studies with a total of 43,042 patients from 13 out of 20 Italian regions, published between 1995 and 2022, estimated that the average incidence of OHCA cases attended by emergency medical services was 86 per 100,000 people annually [14]. The overall survival rate at the longest available follow-up was 9.0%, based on data from 30 studies involving 15,195 patients. This suggests that approximately one in ten individuals experiencing OHCA in Italy survives, which is in the line with evaluated survival rate already observed in literature [14]. Regarding STEMI complicated by OHCA, determining accurate global and European prevalence rates is challenging due to the fact that those patients are usually excluded from the studies.
In conclusion, while STEMI and OHCA are significant health issues, precise prevalence figures and their relationship are not well-defined at the global or European level, underscoring the need for further research and standardized reporting to improve patient outcomes.
Our mission: To reduce the burden of cardiovascular disease.