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Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors
BACKGROUND: Acute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-l...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9047915/ https://www.ncbi.nlm.nih.gov/pubmed/35497977 http://dx.doi.org/10.3389/fcvm.2022.876465 |
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author | Sia, Ching-Hui Ko, Junsuk Zheng, Huili Ho, Andrew Fu-Wah Foo, David Foo, Ling-Li Lim, Patrick Zhan-Yun Liew, Boon Wah Chai, Ping Yeo, Tiong-Cheng Yip, James W. L. Chua, Terrance Chan, Mark Yan-Yee Tan, Jack Wei Chieh Figtree, Gemma Bulluck, Heerajnarain Hausenloy, Derek J. |
author_facet | Sia, Ching-Hui Ko, Junsuk Zheng, Huili Ho, Andrew Fu-Wah Foo, David Foo, Ling-Li Lim, Patrick Zhan-Yun Liew, Boon Wah Chai, Ping Yeo, Tiong-Cheng Yip, James W. L. Chua, Terrance Chan, Mark Yan-Yee Tan, Jack Wei Chieh Figtree, Gemma Bulluck, Heerajnarain Hausenloy, Derek J. |
author_sort | Sia, Ching-Hui |
collection | PubMed |
description | BACKGROUND: Acute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-less”) may be increasing in prevalence and have worse outcomes than “SMuRF-positive” patients. As these studies have been limited to STEMI and comprised mainly Caucasian cohorts, we investigated the changes in the prevalence and mortality of both SMuRF-less STEMI and non-STEMI (NSTEMI) patients in a multiethnic Asian population. METHODS: We evaluated 23,922 STEMI and 62,631 NSTEMI patients from a national multiethnic registry. Short-term cardiovascular and all-cause mortalities in SMuRF-less patients were compared to SMuRF-positive patients. RESULTS: The proportions of SMuRF-less STEMI but not of NSTEMI have increased over the years. In hospitals, all-cause and cardiovascular mortality and 1-year cardiovascular mortality were significantly higher in SMuRF-less STEMI after adjustment for age, creatinine, and hemoglobin. However, this difference did not remain after adjusting for anterior infarction, cardiopulmonary resuscitation (CPR), and Killip class. There were no differences in mortality in SMuRF-less NSTEMI. In contrast to Chinese and Malay patients, SMuRF-less patients of South Asian descent had a two-fold higher risk of in-hospital all-cause mortality even after adjusting for features of increased disease severity. CONCLUSION: SMuRF-less patients had an increased risk of mortality with STEMI, suggesting that there may be unidentified nonstandard risk factors predisposing SMuRF-less patients to a worse prognosis. This group of patients may benefit from more intensive secondary prevention strategies to improve clinical outcomes. |
format | Online Article Text |
id | pubmed-9047915 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90479152022-04-29 Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors Sia, Ching-Hui Ko, Junsuk Zheng, Huili Ho, Andrew Fu-Wah Foo, David Foo, Ling-Li Lim, Patrick Zhan-Yun Liew, Boon Wah Chai, Ping Yeo, Tiong-Cheng Yip, James W. L. Chua, Terrance Chan, Mark Yan-Yee Tan, Jack Wei Chieh Figtree, Gemma Bulluck, Heerajnarain Hausenloy, Derek J. Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Acute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-less”) may be increasing in prevalence and have worse outcomes than “SMuRF-positive” patients. As these studies have been limited to STEMI and comprised mainly Caucasian cohorts, we investigated the changes in the prevalence and mortality of both SMuRF-less STEMI and non-STEMI (NSTEMI) patients in a multiethnic Asian population. METHODS: We evaluated 23,922 STEMI and 62,631 NSTEMI patients from a national multiethnic registry. Short-term cardiovascular and all-cause mortalities in SMuRF-less patients were compared to SMuRF-positive patients. RESULTS: The proportions of SMuRF-less STEMI but not of NSTEMI have increased over the years. In hospitals, all-cause and cardiovascular mortality and 1-year cardiovascular mortality were significantly higher in SMuRF-less STEMI after adjustment for age, creatinine, and hemoglobin. However, this difference did not remain after adjusting for anterior infarction, cardiopulmonary resuscitation (CPR), and Killip class. There were no differences in mortality in SMuRF-less NSTEMI. In contrast to Chinese and Malay patients, SMuRF-less patients of South Asian descent had a two-fold higher risk of in-hospital all-cause mortality even after adjusting for features of increased disease severity. CONCLUSION: SMuRF-less patients had an increased risk of mortality with STEMI, suggesting that there may be unidentified nonstandard risk factors predisposing SMuRF-less patients to a worse prognosis. This group of patients may benefit from more intensive secondary prevention strategies to improve clinical outcomes. Frontiers Media S.A. 2022-04-14 /pmc/articles/PMC9047915/ /pubmed/35497977 http://dx.doi.org/10.3389/fcvm.2022.876465 Text en Copyright © 2022 Sia, Ko, Zheng, Ho, Foo, Foo, Lim, Liew, Chai, Yeo, Yip, Chua, Chan, Tan, Figtree, Bulluck and Hausenloy. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Sia, Ching-Hui Ko, Junsuk Zheng, Huili Ho, Andrew Fu-Wah Foo, David Foo, Ling-Li Lim, Patrick Zhan-Yun Liew, Boon Wah Chai, Ping Yeo, Tiong-Cheng Yip, James W. L. Chua, Terrance Chan, Mark Yan-Yee Tan, Jack Wei Chieh Figtree, Gemma Bulluck, Heerajnarain Hausenloy, Derek J. Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title | Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title_full | Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title_fullStr | Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title_full_unstemmed | Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title_short | Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors |
title_sort | comparison of mortality outcomes in acute myocardial infarction patients with or without standard modifiable cardiovascular risk factors |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9047915/ https://www.ncbi.nlm.nih.gov/pubmed/35497977 http://dx.doi.org/10.3389/fcvm.2022.876465 |
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