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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Mortality After ST-Segment-Elevated Myocardial Infarction Among Patients With and Without Standard Modifiable
Bin Sun1, Chunpo Liang1, Pengfei Sun1
1Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, China (B.S., C.L., P.S., G.A., L.L., L.Z., P.L., Y.L., Q.Y., X.Z.).
Insights
Patients without standard modifiable cardiovascular risk factors (SMuRF) undergoing ST-segment-elevation myocardial infarction treatment face higher 30-day mortality. This increased risk is confined to the initial month post-event, with no significant difference in later mortality.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- ST-segment-elevation myocardial infarction (STEMI) patients lacking standard modifiable cardiovascular risk factors (SMuRF) exhibit increased mortality.
- Understanding the characteristics and outcomes of SMuRF-less STEMI patients is crucial for targeted interventions.
Purpose of the Study:
- To investigate the clinical features, treatments, and outcomes of STEMI patients without SMuRF.
- To analyze the association between SMuRF-less status and mortality in a large, nationwide cohort.
Main Methods:
- A nationwide, multicenter cohort study using data from the Chinese Cardiovascular Association Database-Chest Pain Center.
- Inclusion of adult STEMI patients admitted between 2017-2021, defining SMuRF as hypertension, diabetes, hyperlipidemia, or smoking.
- Assessment of all-cause mortality at 0-30 days and 31-365 days using multivariable Cox regression and landmark analysis.
Main Results:
- 23.1% of 379,811 STEMI patients were SMuRF-less.
- SMuRF-less patients had higher 30-day mortality (10.7% vs 6.7%), independently associated with increased risk (aHR, 1.22).
- No significant difference in 31-365 day mortality was observed between groups (aHR, 1.00), with higher 30-day mortality more pronounced in men.
Conclusions:
- Nearly a quarter of STEMI cases in China are SMuRF-less.
- The excess mortality in SMuRF-less STEMI patients is primarily concentrated within the first 30 days post-admission.
- Subsequent mortality rates do not differ significantly between SMuRF-less and SMuRF patients after the initial 30-day period.
Background:
Patients without standard modifiable cardiovascular risk factors (SMuRF) have an associated increased mortality with ST-segment-elevation myocardial infarction. This study aims to provide insight into the clinical features, treatments, and outcomes of SMuRF-less patients.
Methods:
This nationwide, multicenter cohort study utilized data from the Chinese Cardiovascular Association Database-Chest Pain Center, a national registry derived from electronic medical records of accredited chest pain centers across China. We included adults aged ≥18 years with ST-segment-elevation myocardial infarction admitted between January 1, 2017, and December 31, 2021. The index date was the date of hospital admission. SMuRF included hypertension, diabetes, hyperlipidemia, or smoking, ascertained from medical records at admission. SMuRF-less status was defined as the absence of all 4 risk factors. Outcomes included all-cause mortality at 0 to 30 days and 31 to 365 days. Multivariable Cox regression and landmark analysis were used to assess associations between SMuRF status and mortality.
Results:
Of 379 811 ST-segment-elevation myocardial infarction patients, 87 830 (23.1%) were SMuRF-less. The 30-day all-cause mortality was higher in SMuRF-less patients than in those with SMuRF (10.7% versus 6.7%). After multivariable adjustment, SMuRF-less status remained independently associated with increased 30-day mortality (adjusted hazard ratio, 1.22 [95% CI, 1.19-1.25]). In the 31- to 365-day follow-up period, the mortality rate was numerically higher in the SMuRF-less group (3.8% versus 3.2%), but there was no significance after covariate adjustment (adjusted hazard ratio, 1.00 [95% CI, 0.95-1.04]). The elevated 30-day mortality associated with SMuRF-less status was consistent across most subgroups but significantly more pronounced in men than in women (P for interaction <0.001).
Conclusions:
In this nationwide analysis, nearly one-quarter of ST-segment-elevation myocardial infarction cases were SMuRF-less. Compared with patients with SMuRF, the mortality excess in SMuRF-less patients was confined to the first 30 days, and mortality did not differ subsequently.
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