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.