Background: Marked changes in the epidemiology of acute coronary syndromes (ACS) have been observed over the last few decades in the Western Hemisphere. Incidence rates of ACS in Iceland 2003-2012 are presented.

Methods: All patients with unstable angina (UA), non ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarc­tion (STEMI) admitted to Landspitali were included in the study.  Data were obtained from hospital records and changes during the period were examined.

Results: The total number of ACS cases was 7,502. STEMI incidence was reduced from 98/100,000 inhabitants in 2003 to 63 in 2012, a reduction of nearly 36%. Age standardized incidence rates of STEMI declined annually by 5.5% in men and 5.3% in women (p <0.05). Incidence of NSTEMI increased from 54 /100,000 inhabitants in 2003 to 93 in 2012. UA patients were 56/100,000 inhabitants in 2003, 115 in 2008 and 50 in 2012. No significant annual change in age-standardized incidence rates of NSTEMI and UA was observed. About 35% of patients with NSTEMI and 30% with STEMI and UA were female. The mean age of NSTEMI patients was 72 years, five years higher than patients with STEMI and UA. About 30% of ­pat­ients were living outside of the capital region.

Conclusions: 2003-2012 there was a significant 5% annual ­decrease in the number of STEMI cases and a tendency to ­increasing incidence of NSTEMI which by the end of the research period was the most common of the syndromes. An unusual development in the incidence of UA was observed. Possible effect of psychological stress in the society should be considered.

Table I   Trends in age-standardized incidence of men and women for STEMI, NSTEMI and unstable angina (UA) 2003-2012 (Incidence rate ratio IRR).

Figure 1 Total number of acute coronary syndromes at Landspitali 2003-2012

Figure 2  Acute coronary syndromes per 100.000 inhabitants

Figure 3  Average age of patients with acute coronary syndromes, (STEMI, NSTEMI and unstable angina)