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Mortality and Cardi...
Mortality and Cardiovascular Outcomes in Patients Presenting With Non-ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors : Results From the SWEDEHEART Registry
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- Figtree, Gemma A. (author)
- Royal North Shore Hosp, Kolling Inst, Sydney, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia,Royal North Shore Hospital
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- Vernon, Stephen T. (author)
- Royal North Shore Hosp, Kolling Inst, Sydney, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia,Royal North Shore Hospital
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- Hadziosmanovic, Nermin (author)
- Uppsala University,Uppsala universitet,Kardiologi,Uppsala Univ, Sweden
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- Sundström, Johan, Professor, 1971- (author)
- Uppsala University,Uppsala universitet,Klinisk epidemiologi,UNSW Sydney, George Inst Global Hlth, Sydney, NSW, Australia,Uppsala Univ, Sweden; UNSW Sydney, Australia,University of New South Wales
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- Alfredsson, Joakim (author)
- Linköping University,Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Nicholls, Stephen J. (author)
- Monash Univ, Monash Cardiovasc Res Ctr, Victorian Heart Inst, Clayton, Vic, Australia,Monash University
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- Chow, Clara K. (author)
- Univ Sydney, Westmead Appl Res Ctr, Fac Med & Hlth, Sydney, NSW, Australia.;Westmead Hosp, Dept Cardiol, Sydney, NSW, Australia,Westmead Hospital,University of Sydney
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- Psaltis, Peter (author)
- Univ Adelaide, Vasc Res Ctr, South Australian Hlth & Med Res Inst, Adelaide, SA, Australia.;Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia,University of Adelaide
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- Røsjø, Helge (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Akershus Univ Hosp, Lorenskog, Norway; Univ Oslo, Oslo, Norway,Akershus Univ Hosp, Norway; Univ Oslo, Norway; Uppsala Clin Res Ctr, Sweden,Akershus University Hospital,University of Oslo
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- Leosdottir, Margret (author)
- Lund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups
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- Hagström, Emil (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia,Royal North Shore Hosp, Australia; Uppsala Clin Res Ctr, Sweden,Royal North Shore Hospital
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Royal North Shore Hosp, Kolling Inst, Sydney, NSW, Australia;Univ Sydney, Sydney, NSW, Australia.;Royal North Shore Hosp, Dept Cardiol, Sydney, NSW, Australia Royal North Shore Hospital (creator_code:org_t)
- John Wiley & Sons, 2022
- 2022
- English.
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In: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 11:15
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- atherosclerosis
- coronary artery disease
- myocardial infarction
- risk factors
- atherosclerosis
- coronary artery disease
- myocardial infarction
- risk factors
Publication and Content Type
- ref (subject category)
- art (subject category)
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Figtree, Gemma A ...
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Vernon, Stephen ...
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Hadziosmanovic, ...
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Sundström, Johan ...
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Alfredsson, Joak ...
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Nicholls, Stephe ...
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Chow, Clara K.
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Psaltis, Peter
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Røsjø, Helge
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Leosdottir, Marg ...
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Hagström, Emil
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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Uppsala University
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Linköping University
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Lund University