Myocardial Infarction - Market Insight, Epidemiology And Market Forecast - 2032

DelveInsight's "Myocardial Infarction (MI)- Market Insights, Epidemiology and Market Forecast- 2032" report delivers an in-depth understanding of the MI, historical and forecasted epidemiology as well as the MI market trends in the United States, EU4 (Germany, Spain, Italy, and France), the United Kingdom, and Japan.

MI market report provides current treatment practices, emerging drugs, and market share of the individual therapies, current and forecasted 7MM MI market size from 2019 to 2032. The report also covers current MI treatment practice/algorithm and unmet medical needs to curate the best of the opportunities and assesses the underlying potential of the market.

Geography Covered:

• The United States
• EU4 (Germany, France, Italy, and Spain), and the United Kingdom
• Japan

Study Period: 2019-2032.

Myocardial Infarction (MI) Disease Understanding and Treatment Algorithm

MI Overview

Myocardial infarction (MI) refers to ischemic necrosis of myocardial tissue. The most common underlying cause is coronary artery disease. Type 1 MI occurs when an unstable plaque ruptures, leading to the occlusion of a coronary artery. Type 2 MI occurs when there is a mismatch between oxygen supply and demand (e.g., systemic hypotension, vasospasm). MI manifests clinically with acute coronary syndrome (ACS), a potentially lethal condition.

From a pathologic perspective, MI is defined as cardiomyocyte death caused by an ischemic insult. Application of this definition in the clinical context is challenging because the diagnosis of MI is dependent on the sensitivity and specificity of the clinical criteria, electrocardiographic findings, imaging studies, and biomarkers used to detect the death of cardiomyocytes. In recent years, the development of highly sensitive biomarkers (such as cardiac troponins) has significantly enhanced the clinician's ability to see cardiomyocyte death. It should be emphasized that, although sudden elevations in circulating troponin levels reflect myocardial injury, they are not specific markers of ischemic cardiomyocyte death but in some cases may reflect increased cell wall permeability or release of proteolytic troponin degradation products. Besides, the slow average turnover of cardiomyocytes may be responsible for modest persistent elevations of troponin levels in specific normal individuals

For the sake of immediate treatment strategies such as reperfusion therapy, it is usual practice to designate MI in patients with chest discomfort or other ischemic symptoms who develop new ST-segment elevations in two contiguous leads or new bundle branch blocks with ischemic repolarization patterns as a STEMI. In contrast, patients without STEMI at presentation are usually designated non-ST-elevation MI (NSTEMI). The categories of patients with STEMI, NSTEMI, or unstable angina are customarily included in the concept of ACS.

MI Diagnosis

The initial evaluation of a patient with a suspected AMI should include a focused clinical history, physical examination, electrocardiography, radionuclide imaging, MRI, cardiac markers, and a chest radiograph.

MI Treatment

The goals of initial treatment of an MI are relief of pain, immediate identification of ST changes via 12-lead EKG, initiation of reperfusion (if the patient is a candidate), and assessment and treatment of hemodynamic abnormalities. Pain relief is best achieved with oxygen, nitroglycerin, and morphine sulfate. Patients with ST-segment elevation or a new LBBB with symptoms for 12 h or less are candidates for reperfusion therapy. Further treatment of an MI may be separated into two pathways depending on whether or not the patient has a STEMI or an NSTEMI.

MI Epidemiology

The disease epidemiology covered in the report provides historical as well as forecasted epidemiology segmented by diagnosed prevalent cases of MI, gender-specific prevalence cases of MI, and type-specific cases of MI, in the 7MM market covering the United States, EU4 countries (Germany, France, Italy, and Spain), the United Kingdom, and Japan from 2019 to 2032.

Key Findings

This section provides glimpse of the MI epidemiology in the 7MM.

Country Wise- MI Epidemiology

• The epidemiology segment also provides the MI epidemiology data and findings across the United States, EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan
• The total diagnosed prevalent cases of MI in the 7MM comprised of approximately 15 million cases in 2021 and are projected to increase during the forecasted period
• The total diagnosed prevalent cases of MI in the United States were around 8 million cases in 2021
• The United States contributed to the largest prevalent population of MI, acquiring ~52% of the 7MM in 2021. Whereas, EU4 and the UK, and Japan accounted for around 36% and 11% of total population share, respectively, in 2021
• Among the EU4 countries, Germany accounted for the largest number of diagnosed MI cases followed by France, whereas Spain accounted for the lowest cases in 2021
• According to DelveInsight estimates, there were around 3 million cases of STEMI and 4 million cases of NSTEMI in the United States in 2021. The prevalence is projected to increase during the forecasted period
• In Japan, the prevalent MI cases were around 1.2 million in males and 511 thousand in females in 2021, which is likely to decline during the forecasted period

MI Drug Chapters

Drug chapter segment of the MI report encloses the detailed analysis of MI marketed drugs and late stage (Phase-III and Phase-II) pipeline drugs. It also helps to understand the MI clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug and the latest news and press releases.

Marketed Drugs

INSPRA (eplerenone): Pfizer

INSPRA (eplerenone) is a steroid nucleus-based mineralocorticoid receptor (MR) antagonist with a higher degree of selectivity than spironolactone. Eplerenone is thought to be a more selective blocker at the mineralocorticoid receptor since there is evidence that some of the effects result from a blockade of cortisol stimulation of the MR-receptor. It is indicated for improving survival of stable patients with LV systolic dysfunction (LVEF =40%) and CHF after acute myocardial infarction.

PLAVIX (clopidogrel bisulfate): Sanofi-Aventis/Bristol-Myers Squibb

Sanofi-Aventis's PLAVIX is a P2Y12 platelet inhibitor that reduces the risk of death and cardiovascular complications in patients with symptomatic atherosclerotic disease in the setting of percutaneous coronary intervention (PCI) and in patients with unstable angina or non-STEMI. It is indicated for the acute coronary syndrome (ACS), recent MI, recent stroke, or established peripheral arterial disease.

BRILINTA (ticagrelor): AstraZeneca

BRILINTA (ticagrelor) is an oral, reversible, direct-acting P2Y12 receptor antagonist that works by inhibiting platelet activation. BRILINTA, together with aspirin, has been shown to significantly reduce the risk of MACE, defined as myocardial infarction (MI, heart attack), stroke, or CV death, in patients with ACS or a history of MI. BRILINTA, co-administered with aspirin, is indicated to prevent atherothrombotic events in adult patients with ACS or for patients with a history of MI and a high risk of developing an atherothrombotic event. It is marketed as BRILIQUE in the EU.

PRALUENT (alirocumab): Regeneron/Sanofi

PRALUENT is a PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9) inhibitor antibody developed by Sanofi. In the US, PRALUENT is approved to reduce the risk of heart attack, stroke, and unstable angina. PRALUENT is also approved as an adjunct to diet, alone or in combination with other lipid lowering therapies (e.g., statins, ezetimibe), for the treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce LDL-C

Note: Detailed current therapies assessment will be provided in the full report of MI

Emerging Drugs

FARXIGA/FORXIGA (dapagliflozin): AstraZeneca

Dapagliflozin is a first-in-class, oral, once-daily SGLT2 inhibitor. Research has shown FARXIGA's efficacy in preventing and delaying cardiorenal disease while protecting the organs - important findings given the underlying links between the heart, kidneys, and pancreas. FARXIGA is currently being tested in the DAPA-MI Phase III trial, a first-of-its-kind, registry-based randomized controlled trial in patients without type 2 diabetes following an acute MI or heart attack. The DAPA-MI trial is conducted in collaboration with Uppsala Clinical Research Center (UCR) and Myocardial Ischaemia National Audit Project (MINAP) in the UK. In July 202, AstraZeneca was granted FTD in the US for the development of FARXIGA to reduce the risk of hospitalization for heart failure (hHF) or cardiovascular (CV) death in adults following an AMI or heart attack.

JARDIANCE (empagliflozin): Boehringer Ingelheim and Eli Lilly and Company

Empagliflozin is an inhibitor of sodium-glucose co-transporter-2 (SGLT2), the transporters primarily responsible for glucose re-absorption in the kidney. It is marketed under the brand name JARDIANCE and is the first type 2 diabetes medicine to include cardiovascular death risk reduction data on the label in several countries. Empagliflozin lowers blood glucose levels by preventing glucose re-absorption in the kidneys and increasing the amount of glucose excreted in the urine. It has a relatively long duration of action requiring only once-daily dosing. As its mechanism of action is contingent on the renal excretion of glucose, empagliflozin may be held in cases of acute kidney injury and/or discontinued in patients who develop chronic renal disease In September 2020, the FDA granted FTD for the development of JARDIANCE to prevent hospitalization for heart failure and reduce the risk of mortality in patients with and without diabetes who have had an acute MI.

Olpasiran: Amgen

Olpasiran (formerly AMG 890) is a small interfering RNA designed to lower the body's production of apolipoprotein(a), a key component of Lp(a) that has been associated with an increased risk of cardiovascular events. In November 2022, the company presented end-of-treatment data from its Phase II OCEAN (a)-DOSE study of olpasiran in adults with elevated lipoprotein(a) [Lp(a)] levels (>150 nmol/L) and a history of atherosclerotic cardiovascular disease (ASCVD) during the Late-Breaking Science Session of the American Heart Association (AHA) Scientific Sessions 2022, and simultaneously published in the New England Journal of Medicine. Moreover, the FDA granted Fast Track designation (FTD) for olpasiran to treat atherosclerotic cardiovascular disease

Note: Detailed emerging therapies assessment will be provided in the final report.

MI Market Outlook

Myocardial Infarction (MI) commonly known as a heart attack occurs when blood flow declines or stops in a part of the heart, triggering damage to the heart muscle. Acute myocardial infarction (AMI), a common manifestation of CVD in the elderly, carries an increased risk of mortality, morbidity, and excess costs. Currently, there are multiple effective management options following myocardial infarction, and guidelines recommend lifelong pharmaceutical prevention with beta-blockers, ACE inhibitors or angiotensin II receptor blockers, acetylsalicylic acid, and statins if not contraindicated.

The pharmacologic treatment of MI can be broken down into several groups of medications that improve survival, decrease recurrent ischemic events, and provide symptomatic relief. The primary treatment is followed by multimodal regimen therapies. The treatment starts with rapid diagnostic tests and serial biomarker analysis to classify the disease. For this, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) models are helpful to assess the risk and initiate the treatment plan. The treatment plan includes the initiation of antithrombotic therapy, Sublingual nitroglycerin to control the ischemic and blood pressure conditions. High-intensity statin therapy, angiotensin-converting-enzyme (ACE) inhibitors/ARBs, and Beta-Blockers.

The current market has been segmented accordingly into different commonly used therapeutic classes based on the prevailing treatment pattern across the 7MM, which present itself with minor variations in the overall prescription pattern. Antiplatelet agents, Anticoagulants, Vasodilators, Beta Blockers, Lipid-lowering drugs, Angiotensin-converting Enzyme Inhibitors (ACE), Angiotensin-II receptor Blockers (ARBs), and Calcium channel blockers are the major classes that have been covered in the forecast model.

The dynamics of the MI market are currently changing as a consequence of the recent launch of Proprotein Convertase Subtilisin Kexin Type 9 (Lipid-lowering therapies). The expected launch of new upcoming therapies and greater integration of early patient screening, medication in secondary care and other clinical settings, research on best methods for implementation, and an upsurge in awareness will eventually facilitate the development of effective treatment options. Key players such as Novartis (pelacarsen), Recardio (dutogliptin), Idorsia Pharmaceuticals (selatogrel), Boehringer Ingelheim and Eli Lilly and Company (JARDIANCE), Amgen (olpasiran), Mitsubishi Chemical Group (CL2020), and others are evaluating their lead candidates in different stages of clinical development, respectively. They aim to investigate their products for the treatment of MI.

Key Findings

This section includes a glimpse of the MI in 7MM market.

• The total market size of MI in the 7MM is USD 21,477 million in 2021 and is projected to increase during the forecast period (2022-2032)
• The market size in 7MM will increase at a CAGR of 1.61% due to increasing awareness of the disease and launch of the emerging therapy
• Among EU4 countries, Germany accounts for the maximum market size in 2021 while Spain occupies the bottom of the ladder in 2021
• The market size of MI in Japan is USD 967 million in 2021, which is expected to rise during the forecast period (2022-2032)

The United States Market Outlook

The total market size of MI in the United States is expected to increase with a CAGR of 1.94% during the study period (2019-2032).

EU4, the UK Market Outlook

The total market size of MI in EU4 and the UK is expected to increase with a CAGR of 0.54% during the study period (2019-2032).

Japan Market Outlook

The total market size of MI in Japan is expected to increase with a CAGR of 0.77% during the study period (2019-2032).

Analyst Commentary

• The widespread adoption of a commonly accepted definition for MI and uniform use of cardiac troponin as the biomarker of choice may increase the ability of future studies on MI epidemiology to make more valid inferences about improvements in population cardiovascular health in the short term
• Many major companies are investing in new mechanisms of action for the treatment of MI, such as SGLT2 inhibitors, CX3CR1 inhibitors, FXIa inhibitors, DPP4 inhibitors, ASOs, siRNA and others, which will boost the MI market in the future
• There is a gap in patient-centric information for females, as most of the sign and symptoms information is available for males, leading to silent heart attacks in females. This is the only reason women are underdiagnosed
• Approximately 20% of patients that survive a heart attack will experience a recurrent CV event within one year and about half of these will occur in the first month post index event
• Major cost drivers in the 7MM healthcare system are heart attacks and strokes. The volume of the MI market is incredibly large. The patient receives several therapy concurrently. The smallest patient share portion can provide pharmaceutical companies options worth millions of dollars
• The major threat associated MI pharmacological treatment market is the competition from the emergence of shock devices such as LV assist devices and extracorporeal membrane oxygenation (ECMO)

MI Drugs Uptake

This section focuses on the rate of uptake of the potential drugs expected to get launched in the market during the study period 2019-2032. The analysis covers MI market uptake by drugs; patient uptake by therapies; and sales of each drug. For example- JARDIANCE (empagliflozin) is an inhibitor of sodium-glucose co-transporter-2 (SGLT2), the transporters primarily responsible for glucose re-absorption in the kidney. It is marketed under the brand name JARDIANCE and is the first type 2 diabetes medicine to include cardiovascular death risk reduction data on the label in several countries. Empagliflozin lowers blood glucose levels by preventing glucose re-absorption in the kidneys and increasing the amount of glucose excreted in the urine. It has a relatively long duration of action requiring only once-daily dosing. As its mechanism of action is contingent on the renal excretion of glucose, empagliflozin may be held in cases of acute kidney injury and/or discontinued in patients who develop chronic renal disease. Currently, the company is conducting a Phase III (EMPACT-MI) study for the prevention of chronic heart failure and mortality after an AMI. In September 2020, the US FDA granted Fast Track designation (FTD) for the development of JARDIANCE to prevent hospitalization for heart failure and reduce the risk of mortality in patients with and without diabetes who have had an acute MI. As per our analysis, JARDIANCE drug uptake in the US is expected to be medium with a probability adjusted peak share of 1.5%, years to peak would be 7 years.

MI Pipeline Development Activities

The report provides insights into different therapeutic candidates in Phase III, Phase II, and Phase I stage. It also analyzes key players involved in developing targeted therapeutics.

Pipeline Development Activities

The report covers the detailed information of collaborations, acquisition and merger, licensing and patent details for MI emerging therapies.

KOL- Views

To keep up with current market trends, we take KOLs and SME's opinion working in the domain through primary research to fill the data gaps and validate our secondary research. Some of the leaders from UT Southwestern Medical Center in Dallas, Cancer Research UK Barts Centre in London, MD Anderson Cancer Center. Their opinion helps to understand and validate current and emerging therapies treatment patterns or MI market trend. This will support the clients in potential upcoming novel treatment by identifying the overall scenario of the market and the unmet needs.

Competitive Intelligence Analysis

We perform competitive and market Intelligence analysis of the MI market by using various competitive intelligence tools that include-SWOT analysis, PESTLE analysis, Porter's five forces, BCG Matrix, Market entry strategies, etc. The inclusion of the analysis entirely depends upon the data availability.

Scope of the Report:

• The report covers the descriptive overview of MI, explaining its causes, signs and symptoms, pathogenesis and currently available therapies
• Comprehensive insight has been provided into the MI epidemiology and treatment
• Additionally, an all-inclusive account of both the current and emerging therapies for MI are provided, along with the assessment of new therapies, which will have an impact on the current treatment landscape
• A detailed review of MI market; historical and forecasted is included in the report, covering the 7MM drug outreach
• The report provides an edge while developing business strategies, by understanding trends shaping and driving the 7MM MI market

Report Highlights:

• In the coming years, MI market is set to change due emerging therapies in the pipeline, and incremental healthcare spending across the world; which would expand the size of the market to enable the drug manufacturers to penetrate more into the market
• The companies and academics are working to assess challenges and seek opportunities that could influence MI R&D. The therapies under development are focused on novel approaches to treat/improve the disease condition
• As per DelveInsight's analysis, the major types of MI include STEMI and NSTEMI
• The report also encompasses other major segments, i.e., diagnosed prevalent cases of MI, gender-specific prevalence cases of MI, and type-specific cases of MI
• Expected launch of potential therapies such as FARXIGA/FORXIGA (AstraZeneca), JARDIANCE (Boehringer Ingelheim and Eli Lilly and Company), Olpasiran (Amgen), and Pelacarsen (Novartis), might change the landscape in the treatment of MI
• The US FDA-approved drugs, which are currently available, include INSPRA, PLAVIX, BRILINTA, and others

MI Report Insights

• Patient Population
• Therapeutic Approaches
• MI Pipeline Analysis
• MI Market Size and Trends
• Market Opportunities
• Impact of upcoming Therapies

MI Report Key Strengths

• Eleven Years Forecast
• 7MM Coverage
• MI Epidemiology Segmentation
• Key Cross Competition
• Highly Analyzed Market
• Drugs Uptake

MI Report Assessment

• Current Treatment Practices
• Unmet Needs
• Pipeline Product Profiles
• Market Attractiveness
• SWOT
• Attribute Analysis

Key Questions

Market Insights:

• What was the MI market share (%) distribution in 2019 and how it would look like in 2032?
• What would be the MI total market size as well as market size by therapies across the 7MM during the study period (2019-2032)?
• What are the key findings pertaining to the market across the 7MM and which country will have the largest MI market size during the study period (2019-2032)?
• At what CAGR, the MI market is expected to grow at the 7MM level during the study period (2019-2032)?
• What would be the MI market outlook across the 7MM during the study period (2019-2032)?
• What would be the MI market growth till 2032 and what will be the resultant market size in the year 2032?
• How would the market drivers, barriers and future opportunities affect the market dynamics and subsequent analysis of the associated trends?

Epidemiology Insights:

• What is the disease risk, burden and unmet needs of MI?
• What is the historical MI patient pool in the United States, EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan?
• What would be the forecasted patient pool of MI at the 7MM level?
• What will be the growth opportunities across the 7MM with respect to the patient population pertaining to MI?
• Out of the above-mentioned countries, which country would have the highest incident population of MI during the study period (2019-2032)?
• At what CAGR the population is expected to grow across the 7MM during the study period (2019-2032)?

Current Treatment Scenario, Marketed Drugs and Emerging Therapies:

• What are the current options for the treatment of MI? What are the current treatment guidelines for the treatment of MI in the US and Europe?
• What are the MI marketed drugs and their MOA, regulatory milestones, product development activities, advantages, disadvantages, safety and efficacy, etc.?
• How many companies are developing therapies for the treatment of MI?
• How many emerging therapies are in the mid-stage and late stage of development for the treatment of MI?
• What are the key collaborations (Industry-Industry, Industry-Academia), Mergers and acquisitions, licensing activities related to the MI therapies?
• What are the recent novel therapies, targets, mechanisms of action and technologies developed to overcome the limitation of existing therapies?
• What are the clinical studies going on for MI and their status?
• What are the key designations that have been granted for the emerging therapies for MI?
• What are the 7MM historical and forecasted market of MI?

Reasons to buy:

• The report will help in developing business strategies by understanding trends shaping and driving the MI.
• To understand the future market competition in the MI market and Insightful review of the SWOT analysis of MI.
• Organize sales and marketing efforts by identifying the best opportunities for MI in the US, EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan.
• Identification of strong upcoming players in the market will help in devising strategies that will help in getting ahead of competitors.
• Organize sales and marketing efforts by identifying the best opportunities for MI market.
• To understand the future market competition in the MI market.