Characteristics and in-hospital outcomes of female patients presenting with ST-segment-elevation myocardial infarction without standard modifiable cardiovascular risk factors
{"title":"Characteristics and in-hospital outcomes of female patients presenting with ST-segment-elevation myocardial infarction without standard modifiable cardiovascular risk factors","authors":"","doi":"10.1016/j.cpcardiol.2024.102830","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 %, <em>p</em> < 0.01) and older median age (69 years [IQR: 58–78] vs 67 years [IQR: 57–81], <em>p</em> < 0.01). In comparing co-morbidities, SMuRF-less patients were less likely to have heart failure (28.0 % vs. 23.4 %, <em>p</em> < 0.01), atrial fibrillation/flutter (16.1 % vs. 14.6 %, <em>p</em> = 0.03), chronic pulmonary disease (18.9 % vs. 9.5 %, <em>p</em> < 0.01), obesity (20.7 % vs. 9.2 %, <em>p</em> < 0.01) and aortic disease (1.1 % vs. 0.6 %, <em>p</em> < 0.01). They were however more likely to have dementia (6.9 % vs. 5.7 %, <em>p</em> < 0.01). In evaluating outcomes, SMuRF-less patients had higher in-hospital mortality (aOR 3.2 [95 % CI, 2.9–3.6]; <em>p < 0.01</em>), acute heart failure (aOR 1.6 [95 % CI, 1.4–1.8]; <em>p < 0.01</em>), acute kidney injury (aOR 1.8 [95 % CI, 1.7–2.1]; <em>p < 0.01</em>), and Intra-aortic balloon pump (aOR 1.7 [95 % CI, 1.5–1.9]; <em>p < 0.01</em>). Predictors of higher mortality in SMuRF-less patients include chronic liver disease (OR 6.8, CI 2.4–19.4, <em>p</em> < 0.01), and Hispanic race (OR 1.62, CI 1.1–2.5, <em>p</em> < 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]; <em>p < 0.01</em>) and percutaneous coronary intervention (aOR 0.7 [95 % CI, 0.6–0.8]; <em>p < 0.01</em>).</p></div><div><h3>Conclusion</h3><p>Female SMuRF-less patients presenting with STEMI have worse in-hospital outcomes when compared to patients with ≥1SMuRF.</p></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Problems in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0146280624004651","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
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.
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.