Epidemiological analysis of mortality from acute myocardial infarction compared with mortality from cardiac arrest according to sex and age group in Brazil between 2013 and 2023

Abstract

Cardiovascular diseases remain the leading cause of death worldwide, accounting for nearly one-third of all deaths. Acute myocardial infarction (AMI) and stroke are the most prevalent and lethal forms. Acute coronary occlusion results from an obstruction of coronary blood flow, leading to myocardial necrosis and potentially life-threatening complications, including electrical disturbances that precipitate cardiac arrest. In Brazil, acute coronary syndromes are associated with high morbidity and mortality, with increasing rates of hospitalization and in-hospital death. Cardiorespiratory arrest (CA) is characterized by the sudden failure of cardiac electrical activity and is frequently associated with acute coronary occlusion. Ventricular fibrillation is the most common disturbance in this context and is often fatal if not promptly reversed. The prognosis of cardiac arrest is significantly worse, as the chance of survival decreases dramatically with each minute without cardiopulmonary resuscitation. Since many cases occur in out-of-hospital settings, a considerable proportion of deaths happen before medical assistance, and few patients survive until hospital discharge. The integrated study of acute myocardial infarction and cardiac arrest is essential, as it allows for a better understanding of the mechanisms of cardiac decompensation, identification of risk factors, guidance for prevention strategies and improvement of clinical management policies, while considering differences in age, sex, and healthcare context. This study aimed to analyze mortality trends related to acute myocardial infarction by sex and age group, correlating them with cardiac arrest deaths in Brazil between 2013 and 2023. A retrospective, descriptive and epidemiological study was conducted using secondary data obtained in October 2025 from the Department of Informatics of the Brazilian Unified Health System (DATASUS) through the TABNET platform. Data were extracted from the Mortality Information System (SIM) and the Hospital Information System (SIH/SUS). Variables included the number of deaths due to acute myocardial infarction (ICD-10 I21) and cardiac arrest (ICD-10 I46) by sex and age group in Brazil from 2013 to 2023. During the study period, 1,017,922 deaths from acute coronary occlusion and 20,541 deaths from heart attack were recorded, showing a steady increase. Mortality was higher in men (59.15% for AMI and 56.74% for CA) and in individuals aged ≥80 years (26.67% for AMI and 35.47% for CA) in both analyzed pathologies. Hospital admissions rose by 82.7% in the analyzed period with an average annual growth rate of 6.2%. Despite the decrease in in-hospital acute myocardial infarction mortality by 4.22%, deaths due to cardiac arrest increased substantially, underscoring gaps in early recognition and pre-hospital care. The ratio of acute coronary syndrome to cardiac arrest deaths declined markedly from 107.16 in 2013 to 26.1 in 2023, reflecting both the rise in CA-related mortality and improved detection/reporting. A strong correlation was found between acute myocardial infarction and heart attack (r = 0.79; p = 0.0036), corroborating current bibliographies that state that heart attack is the main cause of cardiac arrest in Brazil, frequently occurring in out-of-hospital settings. Considering the above, the greater vulnerability observed among men and the elderly may be linked to population aging and the impact of the COVID-19 pandemic, which reduced hospital admissions and delayed medical care. Consequently, many acute coronary occlusion deaths have been registered as out-of-hospital cardiac arrest. Despite the decline in in-hospital acute myocardial infarction mortality, cardiac arrest related deaths continue to rise, highlighting the urgent need to strengthen prevention strategies, early diagnosis, and immediate life support to reduce cardiovascular mortality risk.