Clinical outcomes of ST elevation myocardial infarction patients without standard modifiable risk factors
Yu Suresvar Singh1, Hideki Wada1, Manabu Ogita1
1Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) who lacked standard modifiable cardiovascular risk factors (SMuRFs) had higher long-term mortality. This suggests individuals without traditional risk factors still face poor prognosis post-STEMI.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Public Health
Background:
- Standard modifiable cardiovascular risk factors (SMuRFs) include hypertension, diabetes, dyslipidemia, and smoking.
- These factors are established risks for coronary artery disease.
- The prognosis for ST-segment elevation myocardial infarction (STEMI) patients lacking SMuRFs is not well understood.
Purpose of the Study:
- To investigate the association between the absence of SMuRFs and long-term clinical outcomes in STEMI patients.
- To compare mortality rates in STEMI patients with and without SMuRFs.
Main Methods:
- Retrospective analysis of consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) from 1999-2015.
- Primary endpoint: up to 5-year all-cause mortality.
- Comparison of clinical characteristics and outcomes between patients with and without SMuRFs.
Main Results:
- 6.4% of 1963 STEMI patients had no SMuRFs; they were older, leaner, and more often female.
- Patients without SMuRFs exhibited significantly higher cumulative mortality over 5 years (log-rank p < 0.0001).
- Absence of SMuRFs was independently associated with increased mortality risk (HR 1.59, 95% CI 1.14-2.21, p=0.006).
Conclusions:
- STEMI patients without any SMuRFs undergoing primary PCI experienced higher mortality compared to those with at least one SMuRF.
- Individuals without traditional cardiovascular risk factors have a poorer prognosis after STEMI and warrant increased clinical attention.
Background:
Standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) are widely recognized as risk factors for coronary artery disease. However, the associations between absence of SMuRFs and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients are unclear.
Methods:
Consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) between 1999 and 2015 were retrospectively analyzed. The primary endpoint was up to 5-year all-cause mortality. Clinical characteristics and outcomes were compared between patients with at least one of the SMuRFs and those without any SMuRFs.
Results:
Of 1963 STEMI patients, 126 (6.4 %) did not have any SMuRFs. Patients without SMuRFs were significantly older, had lower body mass index, and were more likely to be female. During a median follow-up period of 4.9 years, the cumulative incidence of death was significantly higher in patients without SMuRFs than in those with SMuRFs (log-rank p < 0.0001). Landmark analysis showed that patients without SMuRFs had higher mortality within 30 days of STEMI onset (log-rank p = 0.0045) and >30 days after STEMI onset (log-rank p = 0.0004). Multivariable Cox hazards analysis showed that absence of SMuRFs was associated with a higher risk of mortality (hazard ratio, 1.59; 95 % confidence interval, 1.14-2.21; p = 0.006).
Conclusions:
Of STEMI patients undergoing primary PCI, patients without any SMuRFs had higher mortality than those with at least one of the SMuRFs. Patients without any SMuRFs have a poor prognosis and require more attention.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...