بيانات النشر: Uppsala universitet, Kardiologi
Uppsala universitet, Klinisk epidemiologi
Uppsala universitet, Uppsala kliniska forskningscentrum (UCR)
Royal North Shore Hosp, Kolling Inst, Sydney, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia
UNSW Sydney, George Inst Global Hlth, Sydney, NSW, Australia
Linköping Univ, Fac Med & Hlth Sci, Linköping, Sweden
Monash Univ, Monash Cardiovasc Res Ctr, Victorian Heart Inst, Clayton, Vic, Australia
Univ Sydney, Westmead Appl Res Ctr, Fac Med & Hlth, Sydney, NSW, Australia.;Westmead Hosp, Dept Cardiol, Sydney, NSW, Australia
Univ Adelaide, Vasc Res Ctr, South Australian Hlth & Med Res Inst, Adelaide, SA, Australia.;Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia
Akershus Univ Hosp, Lorenskog, Norway; Univ Oslo, Oslo, Norway
Lund Univ, Dept Clin Sci, Fac Med, Malmö, Sweden
Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia
نبذة مختصرة : Background A significant proportion of patients with ST-segment-elevation myocardial infarction (MI) have no standard modifiable cardiovascular risk factors (SMuRFs) and have unexpected worse 30-day outcomes compared with those with SMuRFs. The aim of this article is to examine outcomes of patients with non-ST-segment-elevation MI in the absence of SMuRFs. Methods and Results Presenting features, management, and outcomes of patients with non-ST-segment-elevation MI without SmuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were compared with those with SmuRFs in the Swedish MI registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies; 2005-2018). Cox proportional hazard models were used. Out of 99 718 patients with non-ST-segment-elevation MI, 11 131 (11.2%) had no SMuRFs. Patients without SMuRFs had higher all-cause and cardiovascular mortality at 30 days (hazard ratio [HR], 1.20 [95% CI, 1.10-1.30], P<0.0001; and HR, 1.25 [95% CI, 1.13-1.38]), a difference that remained after adjustment for age and sex. SMuRF-less patients were less likely to receive secondary prevention statins (76% versus 82%); angiotensin-converting enzyme inhibitors/angiotensin receptor blockade (54% versus 72%); or beta-blockers (81% versus 87%, P for all <0.0001), with lowest rates observed in women without SMuRFs. In patients who survived to 30 days, rates of all-cause and cardiovascular death were lower in patients without SMuRFs compared with those with risk factors, over 12 years. Conclusions One in 10 patients presenting with non-ST-segment-elevation MI present without traditional risk factors. The excess 30-day mortality rate in this group emphasizes the need for both improved population-based strategies for prevention of MI, as well as the need for equitable evidence-based treatment at the time of an MI. ; Correction in: Journal of the American Heart Association, Vol. 12, Issue. 7 DOI:10.1161/JAHA.121.027668
Processing Request
No Comments.