Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors
BackgroundAcute 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-les...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.876465/full |
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| author | Ching-Hui Sia Ching-Hui Sia Junsuk Ko Huili Zheng Andrew Fu-Wah Ho Andrew Fu-Wah Ho Andrew Fu-Wah Ho David Foo Ling-Li Foo Patrick Zhan-Yun Lim Boon Wah Liew Ping Chai Ping Chai Tiong-Cheng Yeo Tiong-Cheng Yeo James W. L. Yip James W. L. Yip Terrance Chua Mark Yan-Yee Chan Mark Yan-Yee Chan Jack Wei Chieh Tan Gemma Figtree Heerajnarain Bulluck Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy |
| author_facet | Ching-Hui Sia Ching-Hui Sia Junsuk Ko Huili Zheng Andrew Fu-Wah Ho Andrew Fu-Wah Ho Andrew Fu-Wah Ho David Foo Ling-Li Foo Patrick Zhan-Yun Lim Boon Wah Liew Ping Chai Ping Chai Tiong-Cheng Yeo Tiong-Cheng Yeo James W. L. Yip James W. L. Yip Terrance Chua Mark Yan-Yee Chan Mark Yan-Yee Chan Jack Wei Chieh Tan Gemma Figtree Heerajnarain Bulluck Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy |
| author_sort | Ching-Hui Sia |
| collection | DOAJ |
| description | BackgroundAcute 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.MethodsWe 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.ResultsThe 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.ConclusionSMuRF-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. |
| first_indexed | 2024-04-13T09:47:13Z |
| format | Article |
| id | doaj.art-20fcd2fe0f454a73a9901bd7e1c39875 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T09:47:13Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-20fcd2fe0f454a73a9901bd7e1c398752022-12-22T02:51:42ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-04-01910.3389/fcvm.2022.876465876465Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk FactorsChing-Hui Sia0Ching-Hui Sia1Junsuk Ko2Huili Zheng3Andrew Fu-Wah Ho4Andrew Fu-Wah Ho5Andrew Fu-Wah Ho6David Foo7Ling-Li Foo8Patrick Zhan-Yun Lim9Boon Wah Liew10Ping Chai11Ping Chai12Tiong-Cheng Yeo13Tiong-Cheng Yeo14James W. L. Yip15James W. L. Yip16Terrance Chua17Mark Yan-Yee Chan18Mark Yan-Yee Chan19Jack Wei Chieh Tan20Gemma Figtree21Heerajnarain Bulluck22Derek J. Hausenloy23Derek J. Hausenloy24Derek J. Hausenloy25Derek J. Hausenloy26Derek J. Hausenloy27Department of Cardiology, National University Heart Centre Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeMD Program, Duke-NUS Medical School, Singapore, SingaporeHealth Promotion Board, National Registry of Diseases Office, Singapore, SingaporeSingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, SingaporeNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, SingaporePre-hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, SingaporeTan Tock Seng Hospital, Singapore, SingaporeHealth Promotion Board, National Registry of Diseases Office, Singapore, SingaporeKhoo Teck Puat Hospital, Singapore, Singapore0Changi General Hospital, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore1Department of Cardiology, National Heart Centre Singapore, Singapore, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore1Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore2Sydney Medical School (Northern), University of Sydney, Sydney, NSW, Australia3Leeds Teaching Hospital NHS trust, Leeds, United KingdomYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore4Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore5The Hatter Cardiovascular Institute, University College London, London, United Kingdom6Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, TaiwanBackgroundAcute 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.MethodsWe 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.ResultsThe 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.ConclusionSMuRF-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.https://www.frontiersin.org/articles/10.3389/fcvm.2022.876465/fullacute myocardial infarctionstandard modifiable cardiovascular disease risk factorsSTEMINSTEMImortalitySMuRF |
| spellingShingle | Ching-Hui Sia Ching-Hui Sia Junsuk Ko Huili Zheng Andrew Fu-Wah Ho Andrew Fu-Wah Ho Andrew Fu-Wah Ho David Foo Ling-Li Foo Patrick Zhan-Yun Lim Boon Wah Liew Ping Chai Ping Chai Tiong-Cheng Yeo Tiong-Cheng Yeo James W. L. Yip James W. L. Yip Terrance Chua Mark Yan-Yee Chan Mark Yan-Yee Chan Jack Wei Chieh Tan Gemma Figtree Heerajnarain Bulluck Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Derek J. Hausenloy Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors Frontiers in Cardiovascular Medicine acute myocardial infarction standard modifiable cardiovascular disease risk factors STEMI NSTEMI mortality SMuRF |
| 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 | acute myocardial infarction standard modifiable cardiovascular disease risk factors STEMI NSTEMI mortality SMuRF |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.876465/full |
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