ST-Segment-Elevation Myocardial Infarction (STEMI) Patients Without Standard Modifiable Cardiovascular Risk
Stephen T Vernon1,2, Sean Coffey3, Mario D'Souza4
1Cardiothoracic and Vascular Health Kolling Institute and Department of Cardiology Royal North Shore Hospital Northern Sydney Local Health District St Leonards Australia.
Insights
A significant and growing number of ST-segment-elevation myocardial infarction (STEMI) cases occur without standard modifiable cardiovascular risk factors (SMuRFs). These SMuRF-less individuals face higher in-hospital mortality, highlighting the need for new prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Standard modifiable cardiovascular risk factors (SMuRFs) are key targets for coronary heart disease prevention.
- Myocardial infarction (MI) in individuals without these risk factors is a recognized clinical challenge.
- Understanding the prevalence and outcomes of MI in SMuRF-less patients is crucial for public health initiatives.
Purpose of the Study:
- To determine the proportion of ST-segment-elevation myocardial infarction (STEMI) patients who are SMuRF-less.
- To analyze the in-hospital mortality and major adverse cardiovascular events (MACE) in SMuRF-less STEMI patients compared to those with SMuRFs.
- To identify trends in the occurrence of SMuRF-less STEMI over time.
Main Methods:
- Analysis of 2 large, sequential, multicenter registries (GRACE and CONCORDANCE) of STEMI patients in Australia (1999-2017).
- Inclusion criteria: STEMI patients without a prior history of cardiovascular disease.
- Outcomes assessed: In-hospital mortality and MACE (death, MI, heart failure) during index admission. Multivariate regression used to identify predictors of MACE.
Main Results:
- 19% of STEMI patients without prior cardiovascular disease history were also SMuRF-less.
- The proportion of SMuRF-less STEMI cases increased from 14% to 23% during the study period (P=0.0067).
- SMuRF-less individuals exhibited higher in-hospital mortality but similar 6-month MACE compared to those with SMuRFs.
Conclusions:
- A substantial and increasing proportion of STEMI cases occur independently of traditional SMuRFs.
- Novel preventative strategies may emerge from identifying new risk markers and mechanisms beyond standard factors.
- Further research is warranted to evaluate the long-term outcomes of SMuRF-less STEMI patients.
Abstract:
Background Programs targeting the standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to tackling coronary heart disease at a community level. However, myocardial infarction in SMuRF-less individuals is not uncommon. This study uses 2 sequential large, multicenter registries to examine the proportion and outcomes of SMuRF-less ST-segment-elevation myocardial infarction (STEMI) patients. Methods and Results We identified 3081 STEMI patients without a prior history of cardiovascular disease in the Australian GRACE (Global Registry of Acute Coronary Events) and CONCORDANCE (Cooperative National Registry of Acute Coronary Syndrome Care) registries, encompassing 42 hospitals, between 1999 and 2017. We examined the proportion that were SMuRF-less as well as outcomes. The primary outcome was in-hospital mortality, and the secondary outcome was major adverse cardiovascular events (death, myocardial infarction, or heart failure, during the index admission). Multivariate regression models were used to identify predictors of major adverse cardiovascular events. Of STEMI patients without a prior history of cardiovascular disease 19% also had no history of SMuRFs. This proportion increased from 14% to 23% during the study period (P=0.0067). SMuRF-less individuals had a higher in-hospital mortality rate than individuals with 1 or more SMuRFs. There were no clinically significant differences in major adverse cardiovascular events at 6 months between the 2 groups. Conclusions A substantial and increasing proportion of STEMI presentations occur independently of SMuRFs. Discovery of new markers and mechanisms of disease beyond standard risk factors may facilitate novel preventative strategies. Studies to assess longer-term outcomes of SMuRF-less STEMI patients are warranted.
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