Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients
BackgroundAn increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patien...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-03-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.869168/full |
| _version_ | 1818287008887341056 |
|---|---|
| author | Gwyneth Kong Nicholas W. S. Chew Cheng Han Ng Yip Han Chin Oliver Z. H. Lim Anand Ambhore Anand Ambhore Gavin Ng Gavin Ng William Kong William Kong Kian-Keong Poh Kian-Keong Poh Roger Foo Roger Foo James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh |
| author_facet | Gwyneth Kong Nicholas W. S. Chew Cheng Han Ng Yip Han Chin Oliver Z. H. Lim Anand Ambhore Anand Ambhore Gavin Ng Gavin Ng William Kong William Kong Kian-Keong Poh Kian-Keong Poh Roger Foo Roger Foo James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh |
| author_sort | Gwyneth Kong |
| collection | DOAJ |
| description | BackgroundAn increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population.MethodsWe recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan–Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality.ResultsStandard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI: 1.09–1.86, p = 0.048), cardiogenic shock (RR: 1.31, 95% CI: 1.09–1.52, p = 0.015), and stroke (RR: 2.51, 95% CI: 1.67–3.34, p = 0.030) among SMuRF-less patients. A 30-day cardiovascular mortality was raised in the SMuRF-less group, with similar trends in men, patients with ST-segment elevation myocardial infarction (STEMI), and the three Asian ethnicities. All-cause mortality remains increased in the SMuRF-less group for up to 5 years.ConclusionThere is a significant proportion of patients with AMI without standard risk factors in Asia, who have worse short-term mortality. This calls for greater focus on the management of this unexpectedly high-risk subgroup of patients. |
| first_indexed | 2024-12-13T01:33:40Z |
| format | Article |
| id | doaj.art-0f05e2b988fe4633b5fddb2429581a9e |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-13T01:33:40Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-0f05e2b988fe4633b5fddb2429581a9e2022-12-22T00:03:56ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-03-01910.3389/fcvm.2022.869168869168Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian PatientsGwyneth Kong0Nicholas W. S. Chew1Cheng Han Ng2Yip Han Chin3Oliver Z. H. Lim4Anand Ambhore5Anand Ambhore6Gavin Ng7Gavin Ng8William Kong9William Kong10Kian-Keong Poh11Kian-Keong Poh12Roger Foo13Roger Foo14James Yip15James Yip16Tiong-Cheng Yeo17Tiong-Cheng Yeo18Adrian Fatt-Hoe Low19Adrian Fatt-Hoe Low20Chi-Hang Lee21Chi-Hang Lee22Mark Yan-Yee Chan23Mark Yan-Yee Chan24Huay-Cheem Tan25Huay-Cheem Tan26Poay-Huan Loh27Poay-Huan Loh28Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre, National University Health System, Singapore, SingaporeBackgroundAn increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population.MethodsWe recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan–Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality.ResultsStandard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI: 1.09–1.86, p = 0.048), cardiogenic shock (RR: 1.31, 95% CI: 1.09–1.52, p = 0.015), and stroke (RR: 2.51, 95% CI: 1.67–3.34, p = 0.030) among SMuRF-less patients. A 30-day cardiovascular mortality was raised in the SMuRF-less group, with similar trends in men, patients with ST-segment elevation myocardial infarction (STEMI), and the three Asian ethnicities. All-cause mortality remains increased in the SMuRF-less group for up to 5 years.ConclusionThere is a significant proportion of patients with AMI without standard risk factors in Asia, who have worse short-term mortality. This calls for greater focus on the management of this unexpectedly high-risk subgroup of patients.https://www.frontiersin.org/articles/10.3389/fcvm.2022.869168/fullhypertensionhyperlipidemiadiabetesstandard modifiable cardiovascular risk factorsprognostic outcomessmoking |
| spellingShingle | Gwyneth Kong Nicholas W. S. Chew Cheng Han Ng Yip Han Chin Oliver Z. H. Lim Anand Ambhore Anand Ambhore Gavin Ng Gavin Ng William Kong William Kong Kian-Keong Poh Kian-Keong Poh Roger Foo Roger Foo James Yip James Yip Tiong-Cheng Yeo Tiong-Cheng Yeo Adrian Fatt-Hoe Low Adrian Fatt-Hoe Low Chi-Hang Lee Chi-Hang Lee Mark Yan-Yee Chan Mark Yan-Yee Chan Huay-Cheem Tan Huay-Cheem Tan Poay-Huan Loh Poay-Huan Loh Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients Frontiers in Cardiovascular Medicine hypertension hyperlipidemia diabetes standard modifiable cardiovascular risk factors prognostic outcomes smoking |
| title | Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients |
| title_full | Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients |
| title_fullStr | Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients |
| title_full_unstemmed | Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients |
| title_short | Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients |
| title_sort | prognostic outcomes in acute myocardial infarction patients without standard modifiable risk factors a multiethnic study of 8 680 asian patients |
| topic | hypertension hyperlipidemia diabetes standard modifiable cardiovascular risk factors prognostic outcomes smoking |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.869168/full |
| work_keys_str_mv | AT gwynethkong prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT nicholaswschew prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT chenghanng prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT yiphanchin prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT oliverzhlim prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT anandambhore prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT anandambhore prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT gavinng prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT gavinng prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT williamkong prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT williamkong prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT kiankeongpoh prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT kiankeongpoh prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT rogerfoo prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT rogerfoo prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT jamesyip prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT jamesyip prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT tiongchengyeo prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT tiongchengyeo prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT adrianfatthoelow prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT adrianfatthoelow prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT chihanglee prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT chihanglee prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT markyanyeechan prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT markyanyeechan prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT huaycheemtan prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT huaycheemtan prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT poayhuanloh prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients AT poayhuanloh prognosticoutcomesinacutemyocardialinfarctionpatientswithoutstandardmodifiableriskfactorsamultiethnicstudyof8680asianpatients |