The crude incidence rate of acute myocardial infarction (MI) per 100,000 person-years demonstrated a consistent increase from 44.7 in 2011 to 68.3 in 2019, representing a cumulative increase of 54%. However, in 2020, this incidence rate declined slightly to 66.2. [1]  

According to Health Insurance Review and Assessment disease statistics, the number of patients with a diagnostic code of I21 or I22 was 122,231 in 2020, which translates to a prevalence of 0.343% of Korean adults aged 30 years and older. The annual prevalence was 0.278% in 2016, 0.291% in 2017, 0.317% in 2018, and 0.337% in 2019, indicating a gradual increase between 2016 and 2020. [2] 

The relative risk (RR) for 30-day acute myocardial infarction mortality remained at 1.2 in both 2008 and 2019. The mortality rate of OECD (Organization for Economic Co-operation and Development) countries showed a continuous decline, with an average annual percent change of –2.5% between 2008 (11.9%) and 2019 (8.9%). [3] 

In 2020, the age-standardized incidence rate of acute myocardial infarction in males was 92.1 per 100,000 persons, reflecting a steady increase from 2011 with a slight tapering off in the final year. In contrast, the rate in females showed only minimal change over the same period, reaching 35.5 per 100,000 persons in 2020. [1] 

In 2020, the number of acute myocardial infarction events increased with age: 9 cases occurred in individuals under 20, 80 in those aged 20–29, 572 in the 30–39 group, 2,873 among those aged 40–49, 6,990 in the 50–59 group, 9,047 in those aged 60–69, 7,850 in the 70–79 group, and 6,567 cases were reported in individuals aged 80 and older. [1] 

Daegu, Jeju, and Gwangju Province showed the highest average AMI incidence rates of 50.3, 47.3, and 47.1 per 100,000 person-years, respectively. On the other hand, Sejong, Chungnam, and Incheon Province showed low average incidence rates of 30.2, 37.9, and 38.4 per 100,000 person-years, respectively. The highest incidence rate of Daegu city was relatively 66.6% higher than that of the lowest Sejong city. [4] 

ST-elevation myocardial infarction (STEMI) decreased from 64.3% in 2005 to 48.4% in 2018, and thus the ratio of STEMI/Non-STEMI decreased in 2012 (p for trend < 0.001). [5] 

Epigastric pain was the most commonly reported symptom of acute myocardial infarction, observed in 41.7% of patients, followed by cold sweats (29.4%), dyspnea (29.0%), central chest pain (20.0%), left shoulder pain (12.1%), and pain in the left side of the chest (12.0%). In contrast, previous domestic studies identified chest pain as the most common symptom, reported in approximately 60% of cases, along with dyspnea, fatigue or dizziness, and nausea and vomiting. These findings differ from the present study, in which epigastric pain was the most frequently reported symptom. [6] 

Among the cardiovascular risk factors, The Korea Acute Myocardial Infarction Registry data from November 2005 to August 2018 revealed that hypertension is the most common comorbidity (57.2%), followed by current smoking (40.6%), diabetes mellitus (DM; 32.3%), and dyslipidemia (13.2%).[5]  

Criteria for acute myocardial infarction (types 1, 2 and 3 MI) The term acute myocardial infarction should be used when there is acute myocardial injury with clinical evidence of acute myocardial ischaemia and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th percentile URL and at least one of the following: Symptoms of myocardial ischaemia; New ischaemic Electrocardiogram changes; Development of pathological Q waves; Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischaemic aetiology; Identification of a coronary thrombus by angiography or autopsy (not for type 2 or 3 MIs). [7] 

99.1% of STEMI patients in Korea underwent primary percutaneous coronary intervention (PCI) in 2018. And, drug-eluting stents (DESs), almost exclusively newer-generation DESs, were implanted in 99.6% of patients with primary PCI. Thus, nearly all STEMI patients underwent primary PCI with newer-generation DES, in accordance with recent European Society of Cardiology (ESC) guidelines. [8]  Statins, renin-angiotensin system (RAS) blockers, and beta blockers are prescribed in approximately 80% of all AMI patients. RAS blockers, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARBs), are prescribed more for Korean patients with AMI (85.4%, 86.4%, and 89.6% of acute MI, STEMI, and NSTEMI patients, respectively) compared with those in French and Swedish registries (64.0% and 57.0% of STEMI and NSTEMI patients, respectively, in the French registry and 56.2% of AMI patients in the Swedish registry. [5]

Data from KAMIR compared the clinical impact of a pharmacoinvasive strategy with primary PCI in STEMI patients. Most patients (n=8,878) underwent primary PCI at a median 105 minutes after symptom onset, whereas 708 patients underwent thrombolysis and subsequent PCI. The 12-month incidences of death (4.4% vs. 4.1%) and major adverse cardiac events (7.5% vs. 7.8%) were similar in the 2 groups. [8] 

In Korean early-onset acute myocardial infarction patients who underwent percutaneous coronary intervention, the polygenic risk score distribution was significantly higher compared to the control group. The odds ratio associated with the polygenic risk score was 1.83 in patients, indicating a higher genetic risk burden. [9] 

[1] Incidence and case fatality of acute myocardial infarction in Korea, 2011-2020. Epidemiol Health. 2024;46:e2024002. [2] Epidemiology of myocardial infarction in Korea: hospitalization incidence, prevalence, and mortality. Epidemiol Health. 2022;44:e2022057. [3] Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019. Yonsei Med J. 2024 Sep;65(9):534-543. [4] The Trend in Incidence and Case-fatality of Hospitalized Acute Myocardial Infarction Patients in Korea, 2007 to 2016. J Korean Med Sci. 2019 Nov;34(50):e322. [5] Current status of acute myocardial infarction in Korea. Korean J Intern Med. 2019 Jan;34(1):1-10.  [6] Symptom Clusters in Korean Patients with Acute Myocardial Infarction. Journal of Korean Academy of Nursing, 45(3), 378-387. (2015)  [7] Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13;138(20):e618-e651. [8] 2021 Korean Society of Myocardial Infarction Expert Consensus Document on Revascularization for Acute Myocardial Infarction. Korean Circ J. 2021 Apr;51(4):289-307. [9] Polygenic risk score validation using Korean genomes of 265 early-onset acute myocardial infarction patients and 636 healthy controls. PLoS One. 2021 Feb 4;16(2):e0246538.