Time-Trends in Case-Fatality After Acute Myocardial Infarction Among Middle-Aged Lithuanian Adults, 2000–2023: Data from the Population-Based Kaunas Ischemic Heart Disease Register

Background and Objectives. Over the past two decades, 28-day acute myocardial infarction (AMI) case-fatality rates have declined globally due to improved treatment and secondary prevention. This study aimed to evaluate AMI case-fatality levels and trends in the Kaunas population aged 25–64 from 2000 to 2023. Materials and Methods. Data were obtained from the population-based Kaunas Ischemic Heart Disease Registry, operating under the WHO MONICA standards. The study included adults with AMI or coronary heart disease death registered within 28 days from the onset of AMI. Case-fatality was defined as the proportion of AMI deaths among all AMI cases. Trends were assessed using JoinPoint regression. Results. From 2000 to 2023, 28-day AMI case-fatality in males showed no significant change, while in females it increased by 2.5% per year (p = 0.002). In-hospital AMI case-fatality remained stable in both sexes. Males had higher average AMI case-fatality rates than females in both age groups (25–54 and 55–64). Only females aged 55–64 showed a significant rise in AMI case-fatality (3.0%/year, p = 0.002). A trend change point was identified in 2006 for males (no significant trend) and in 2010 for females, after which the AMI case-fatality rates increased. Among males, in-hospital AMI case-fatality decreased significantly from 2015 to 2023 (14.7%/year). Conclusions. Over the two decades, 28-day AMI case-fatality among 25–64-year-old-persons remained unchanged in males but increased in females. In-hospital AMI case-fatality showed no major change in either sex. Males consistently had higher AMI case-fatality rates with age. While aging did not affect AMI case-fatality trends in males, rates rose significantly among older females.