Characteristics and in-hospital outcomes of female patients presenting with ST-segment-elevation myocardial infarction without standard modifiable cardiovascular risk factors

IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Problems in Cardiology Pub Date : 2024-09-04 DOI:10.1016/j.cpcardiol.2024.102830
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Abstract

Background

Standard Modifiable Cardiovascular Risk Factors (SMuRF) such as hypertension, diabetes mellitus, hyperlipidemia, and smoking have long been established in the etiology of atherosclerotic disease. We evaluate in-hospital outcomes of female STEMI patients without these risk factors.

Methods

The National Inpatient Sample databases (2016 to 2021) were queried to identify STEMI admissions as a principal diagnosis using ICD 10 codes. Patients with a history of coronary artery disease, myocardial infarction, coronary bypass graft, percutaneous coronary intervention, takotsubo cardiomyopathy, cocaine abuse, and spontaneous coronary dissection and males were excluded from our study population. A final study population aged >18 years was divided into cohorts of SMuRF and SMuRF-less based on the presence of ≥1 risk factor. Multivariate logistic regression model adjusting for baseline characteristics and comorbidities. The primary outcome was in-hospital mortality. The secondary outcomes are STEMI-related complications and the use of mechanical circulatory support devices.

Results

200,980 patients were identified. 187,776 (93.4 %) patients were identified as having ≥1 SMuRF, and 13,205 (6.6 %) patients were SMuRF-less. Compared to SMuRF patients, SMuRF-less patients are more likely to be white (75.6 % vs. 73.1 %, p < 0.01) and older median age (69 years [IQR: 58–78] vs 67 years [IQR: 57–81], p < 0.01). In comparing co-morbidities, SMuRF-less patients were less likely to have heart failure (28.0 % vs. 23.4 %, p < 0.01), atrial fibrillation/flutter (16.1 % vs. 14.6 %, p = 0.03), chronic pulmonary disease (18.9 % vs. 9.5 %, p < 0.01), obesity (20.7 % vs. 9.2 %, p < 0.01) and aortic disease (1.1 % vs. 0.6 %, p < 0.01). They were however more likely to have dementia (6.9 % vs. 5.7 %, p < 0.01). In evaluating outcomes, SMuRF-less patients had higher in-hospital mortality (aOR 3.2 [95 % CI, 2.9–3.6]; p < 0.01), acute heart failure (aOR 1.6 [95 % CI, 1.4–1.8]; p < 0.01), acute kidney injury (aOR 1.8 [95 % CI, 1.7–2.1]; p < 0.01), and Intra-aortic balloon pump (aOR 1.7 [95 % CI, 1.5–1.9]; p < 0.01). Predictors of higher mortality in SMuRF-less patients include chronic liver disease (OR 6.8, CI 2.4–19.4, p < 0.01), and Hispanic race (OR 1.62, CI 1.1–2.5, p < 0.01). We also found that SMuRF-less patients were less likely to undergo coronary angiography (aOR 0.5 [95 % CI, 0.4–0.5]; p < 0.01) and percutaneous coronary intervention (aOR 0.7 [95 % CI, 0.6–0.8]; p < 0.01).

Conclusion

Female SMuRF-less patients presenting with STEMI have worse in-hospital outcomes when compared to patients with ≥1SMuRF.

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无标准可改变心血管风险因素的 ST 段抬高型心肌梗死女性患者的特征和院内预后。
背景:高血压、糖尿病、高脂血症和吸烟等标准可改变心血管风险因素(SMuRF)早已被认为是动脉粥样硬化疾病的病因。我们对不存在这些风险因素的 STEMI 女性患者的院内预后进行了评估:查询全国住院患者抽样数据库(2016 年至 2021 年),使用 ICD 10 编码确定 STEMI 入院的主要诊断。有冠状动脉疾病、心肌梗死、冠状动脉旁路移植术、经皮冠状动脉介入治疗、塔克次氏体心肌病、可卡因滥用、自发性冠状动脉夹层病史的患者和男性被排除在我们的研究人群之外。根据是否存在≥1个危险因素,将年龄大于18岁的最终研究人群分为SMuRF和无SMuRF人群。多变量逻辑回归模型调整了基线特征和合并症。主要结果是院内死亡率。次要结果是 STEMI 相关并发症和机械循环支持装置的使用。187776名患者(93.4%)被确定为≥1例SMuRF,13205名患者(6.6%)无SMuRF。与SMuRF患者相比,无SMuRF患者更可能是白人(75.6%对73.1%,p结论:与SMuRF≥1的患者相比,无SMuRF的STEMI女性患者的院内预后更差。
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来源期刊
Current Problems in Cardiology
Current Problems in Cardiology 医学-心血管系统
CiteScore
4.80
自引率
2.40%
发文量
392
审稿时长
6 days
期刊介绍: Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.
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