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Time trends of myocardial infarction 28-day case-fatality in the 1990s: is there a contribution from different changes among socioeconomic classes?
  1. C Fornari1,
  2. G C Cesana1,
  3. L E Chambless2,
  4. G Corrao3,
  5. R Borchini4,
  6. F Madotto1,
  7. M M Ferrario1,4
  1. 1
    Centro di Studio e Ricerca sulla Patologia Cronico-Degenerativa negli Ambienti di Lavoro, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Universitè degli Studi di Milano-Bicocca, Monza, Italy
  2. 2
    Collaborative Studies Coordinating Centre, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
  3. 3
    Dipartimento di Statistica, Universitè degli Studi di Milano-Bicocca, Milano, Italy
  4. 4
    Medicina del Lavoro e Preventiva, Dipartimento di Scienze Cliniche e Biologiche, Universitè degli Studi dell’Insubria e Ospedale di Circolo-Fondazione Macchi, Varese, Italy
  1. Professor G Cesana, Universitè degli Studi di Milano-Bicocca, Villa Serena 6° piano, Via Pergolesi 33, I-20152, Monza, Italy; giancarlo.cesana{at}


Background/objective: Almost two-thirds of the coronary death rate decrease in the northern Italian Brianza MONICA male population, between 1993–4 and 1997–8, are attributable to a reduction in 28-day myocardial infarction (MI) case-fatality. The present paper investigates the factors associated with MI case-fatality decrease and in particular the role of socio-occupational classes (SOCs).

Methods: Standardised information on acute coronary care and intervention before and during the hospitalisation was collected for all coronary events (n = 1817) registered in 1993–4 and in 1997–8 among 35–64-year-old male residents in Brianza. Deaths within 28 days after MI were carefully investigated. Five SOCs were defined adopting the Erikson-Goldthorpe-Portocarero method. Differences in 28-day MI case-fatality and in acute phase intervention and treatment over time and among SOCs in each period were assessed.

Results: 28-day MI case-fatality reduction (27.2%) can be mainly attributed to a decreased proportion of MI events that were fatal before reaching the hospital. In the lower SOCs significant changes in MI case-fatality were detected between 1993–4 and 1997–8. Differences in acute phase intervention and treatment between the periods were observed. SOC differences both in prevalence of out-of-hospital cardiac arrest and in the pre-hospital qualified intervention score were detected in the first period only.

Conclusions: In the study population MI case-fatality reduction can be mainly attributed to a more effective and prompt management before hospitalisation and to an improvement in acute treatment during hospitalisation. This enhancement is made available to the whole population overtaking social differences.

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  • MONICA Brianza-CAMUNI Research Group: Marco Mario Ferrario, Carla Fornari, Lauretta Bolognesi, Maria Teresa Gussoni, Roberto Vercellino, Simone Sarman, Marco Benedetti, Rita Facchetti, Chiara Carenzi, Roberto Sega, Giancarlo Cesana (Centro di Studio e Ricerca sulla Patologia Cronico-Degenerativa negli Ambienti di Lavoro, Universitè degli Studi di Milano-Bicocca, Monza).

  • Funding: The MI Register in Brianza has been mainly supported by the Health Administration of Regione Lombardia (grant nos VI/31737–1997 and VII/17155–2004).

  • Competing interests: None.

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