Changing Epidemiology of Acute Myocardial Infarction in the High-Sensitivity Cardiac Troponin Era
- 1Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign
Abstract
Contemporary national-scale electronic health record (EHR) trends in documented acute myocardial infarction (AMI) rates during the high-sensitivity cardiac troponin (hs-cTn) and Type 2 myocardial infarction (T2MI) era are not well characterized. We conducted a serial cross-sectional analysis of U.S. adults aged [≥]18 years in Epic Cosmos from 2016-2024, encompassing 821,859,867 patient-years. Age- and sex-standardized AMI diagnosis rates increased 75.7%, from 343.1 to 602.7 per 100,000 patients. This increase was predominantly driven by T2MI, which increased 133.8% from 99.9 per 100,000 in 2018 to 233.4 per 100,000 in 2024; NSTEMI increased 13.8% while STEMI decreased 4.1%. Annual hs-cTn-tested encounters increased 34.5-fold from 2017 through 2024. The proportion of tested encounters associated with any AMI remained relatively stable after 2021, whereas T2MI continued to increase and surpassed NSTEMI in 2024 as the most frequently diagnosed AMI subtype per hs-cTn-tested encounters. Males had higher absolute AMI rates across all age groups, although relative increases were greater among females. Documented AMI epidemiology shifted substantially toward T2MI during expanding hs-cTn utilization, underscoring the need for evidence-based approaches to the evaluation and management of T2MI.
Related
- Single High-Sensitivity Cardiac Troponin Measurement to Rule-out/Rule-in Myocardial Infarction in the Emergency Department
- Angiographic prevalence of occlusion myocardial infarction and the limited value of serial troponin in patients with non-ST-segment elevation acute coronary syndrome.
- Association of Baseline and Serial High-Sensitivity Cardiac Troponin T with In-Hospital Mortality Across Clinical Presentation, LVEF and Diabetes Status in Decompensated Heart Failure
- Safety and efficiency of the HEART-GP strategy with point-of-care high-sensitivity troponin testing for acute chest pain in out-of-hours primary care: a prospective multicentre diagnostic accuracy study
- High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors
BibTeX
@misc{taylor2026changing,
title = {{Changing Epidemiology of Acute Myocardial Infarction in the High-Sensitivity Cardiac Troponin Era}},
author = {B. Taylor and C. Oltman and J. Shtembari and N. Adoni},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.26.26361490},
url = {https://www.medrxiv.org/content/10.64898/2026.08.26.26361490v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Changing Epidemiology of Acute Myocardial Infarction in the High-Sensitivity Cardiac Troponin Era
AU - B. Taylor
AU - C. Oltman
AU - J. Shtembari
AU - N. Adoni
PY - 2026
DA - 2026/08/26
PB - medRxiv
DO - 10.64898/2026.08.26.26361490
UR - https://www.medrxiv.org/content/10.64898/2026.08.26.26361490v1
AB - Contemporary national-scale electronic health record (EHR) trends in documented acute myocardial infarction (AMI) rates during the high-sensitivity cardiac troponin (hs-cTn) and Type 2 myocardial infarction (T2MI) era are not well characterized. We conducted a serial cross-sectional analysis of U.S. adults aged [≥]18 years in Epic Cosmos from 2016-2024, encompassing 821,859,867 patient-years. Age- and sex-standardized AMI diagnosis rates increased 75.7%, from 343.1 to 602.7 per 100,000 patients. This increase was predominantly driven by T2MI, which increased 133.8% from 99.9 per 100,000 in 2018 to 233.4 per 100,000 in 2024; NSTEMI increased 13.8% while STEMI decreased 4.1%. Annual hs-cTn-tested encounters increased 34.5-fold from 2017 through 2024. The proportion of tested encounters associated with any AMI remained relatively stable after 2021, whereas T2MI continued to increase and surpassed NSTEMI in 2024 as the most frequently diagnosed AMI subtype per hs-cTn-tested encounters. Males had higher absolute AMI rates across all age groups, although relative increases were greater among females. Documented AMI epidemiology shifted substantially toward T2MI during expanding hs-cTn utilization, underscoring the need for evidence-based approaches to the evaluation and management of T2MI.
ER -