eAppendix
Diagnostic criteria for acute myocardial infarction in SHEEP
Starting in 1991, joint diagnostic criteria for AMI were applied in all hospitals in the Stockholm County. These were in line with current international standards and were acknowledged by the Swedish Society of Cardiology.
A diagnosis of AMI required autopsy findings showing myocardial necrosis with an age compatible with the time of disease onset or that two of the three criteria below were met.
1) Symptoms according to the case history include
- pain, pressure and/or a burning sensation centrally in chest with an onset 24 hrs before the diagnosis as earliest, with a duration >15 min and without any apparent correlation with breathing, body position or food intake;
- accumulating attacks at rest as above, but with a duration <15 min, during the past 24 hrs;
- pulmonary edema;
- shock without suspicion of bleeding, hypovolemy, sepsis or intoxication;
- an episode of fainting during the past 24 hrs.
2) Changes in levels of cardiac enzymes (CK, CK-MB, LD, LD1) with
- at least one CK>3.3 μkat/l for men, CK>2.5 μkat/l for women, with CK-B above 0.2 μkat/l; ratio CK-B/CK 3-12%; maximum value reached ca 15-18 hrs after first appearance of symptoms;
- two LD values above 8.0 μkat/l with LD1 above 3.3 μkat/l; maximum value reached ca 36-48 hrs after first appearance of symptoms.
3) Development of pathologic Q waves in ≥2 leads on the ECG.
eFigure. Flow chart showing losses due to non-participation, restrictions and non- available information.
5452 eligible subjects
4069 (75%) participated in the study 3598 (88%) born in Sweden 2586 (72%) with birth records available
2536 (98%) born as singletons 1928 non-fatal cases and
their controls, eligible for health examination
608 fatal cases and their controls*
1731 (90%) participated in physical examination and blood sampling
~25 % blood samples lost due to freezer break down (before the measurements of insulin were done)