Mortality and Cardiovascular Outcomes in Patients Presenting With Non–ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors : Results From the SWEDEHEART Registry

Figtree, Gemma A.; Vernon, Stephen T.; Hadziosmanovic, Nermin; Sundstrom, Johan; Alfredsson, Joakim; Nicholls, Stephen J.; Chow, Clara K.; Psaltis, Peter; Rosjo, Helge; Leosdottir, Margret; Hagstrom, Emil

Mortality and Cardiovascular Outcomes in Patients Presenting With Non–ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors : Results From the SWEDEHEART Registry

Mark

Figtree, Gemma A. ; Vernon, Stephen T. ; Hadziosmanovic, Nermin ; Sundstrom, Johan ; Alfredsson, Joakim ; Nicholls, Stephen J. ; Chow, Clara K. ; Psaltis, Peter ; Rosjo, Helge and Leosdottir, Margret ^LU , et al. (2022) In Journal of the American Heart Association 11(15).

Abstract: 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... (More); 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 β-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.
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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/28672bc7-b61d-408d-b71e-27fa26eee31d

author

Figtree, Gemma A. ; Vernon, Stephen T. ; Hadziosmanovic, Nermin ; Sundstrom, Johan ; Alfredsson, Joakim ; Nicholls, Stephen J. ; Chow, Clara K. ; Psaltis, Peter ; Rosjo, Helge and Leosdottir, Margret ^LU , et al. (More)

Figtree, Gemma A. ; Vernon, Stephen T. ; Hadziosmanovic, Nermin ; Sundstrom, Johan ; Alfredsson, Joakim ; Nicholls, Stephen J. ; Chow, Clara K. ; Psaltis, Peter ; Rosjo, Helge ; Leosdottir, Margret ^LU and Hagstrom, Emil (Less)

organization

publishing date

2022-08-02

type

Contribution to journal

publication status

published

subject

Cardiac and Cardiovascular Systems

keywords

atherosclerosis, coronary artery disease, myocardial infarction, risk factors

in

Journal of the American Heart Association

volume

11

issue

15

article number

e024818

publisher

Wiley-Blackwell

external identifiers

scopus:85135500158
pmid:35876409

ISSN

2047-9980

DOI

10.1161/JAHA.121.024818

language

English

LU publication?

yes

id

28672bc7-b61d-408d-b71e-27fa26eee31d

date added to LUP

2022-10-28 14:42:57

date last changed

2024-05-03 17:45:10

@article{28672bc7-b61d-408d-b71e-27fa26eee31d,
  abstract     = {{<p>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&lt;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 β-blockers (81% versus 87%, P for all &lt;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.</p>}},
  author       = {{Figtree, Gemma A. and Vernon, Stephen T. and Hadziosmanovic, Nermin and Sundstrom, Johan and Alfredsson, Joakim and Nicholls, Stephen J. and Chow, Clara K. and Psaltis, Peter and Rosjo, Helge and Leosdottir, Margret and Hagstrom, Emil}},
  issn         = {{2047-9980}},
  keywords     = {{atherosclerosis; coronary artery disease; myocardial infarction; risk factors}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{15}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Mortality and Cardiovascular Outcomes in Patients Presenting With Non–ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors : Results From the SWEDEHEART Registry}},
  url          = {{http://dx.doi.org/10.1161/JAHA.121.024818}},
  doi          = {{10.1161/JAHA.121.024818}},
  volume       = {{11}},
  year         = {{2022}},
}

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Mortality and Cardiovascular Outcomes in Patients Presenting With Non–ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors : Results From the SWEDEHEART Registry