International comparison of treatment and long-term outcomes for acute myocardial infarction in the elderly: Minneapolis/St. Paul, MN, USA and Goteborg, Sweden

Eur Heart J. 2013 Nov;34(41):3191-7. doi: 10.1093/eurheartj/eht196. Epub 2013 Jun 25.


Aims: International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and Göteborg, Sweden (GB).

Methods and results: A population-based sample of hospitalized AMI (ICD-9 410) patients aged ≥75 in MSP and GB in 2001-02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83 ± 7, GB 82 ± 5; women: MSP 84 ± 6, GB 84 ± 6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline-based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% among GB patients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50-0.88] and women (HR: 0.49, 95% CI: 0.36-0.67) compared with GB.

Conclusion: In MSP and GB, guideline-based therapy use was high. However, PCI use was markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.

Keywords: Acute myocardial infarction; Elderly; International comparison.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged, 80 and over
  • Cardiovascular Agents / therapeutic use
  • Coronary Angiography / statistics & numerical data
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Minnesota / epidemiology
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Prescription Drugs / therapeutic use
  • Sex Distribution
  • Sweden / epidemiology
  • Treatment Outcome


  • Cardiovascular Agents
  • Prescription Drugs