Clinical outcomes and coronary artery lesion characteristics of young patients with ST elevation myocardial infarction and no standard modifiable risk factors

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-09-09 DOI:10.1002/ccd.31205

Nick S. R. Lan MBBS (Hons), MClinUS, MClinRes (Dist), MSc, HuiJun Chih BSc (Hons), PhD, Angela L. Brennan CCRN, Girish Dwivedi MD, PhD, Gemma A. Figtree MBBS, DPhil, Diem Dinh PhD, Dion Stub MBBS, PhD, Christopher M. Reid MSc, PhD, Abdul Rahman Ihdayhid MBBS (Hons), PhD, The ASPECT Investigators

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Abstract

Background

Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear.

Methods

Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used.

Results

Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24–4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06–6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001).

Conclusions

Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.

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ST段抬高型心肌梗死且无标准可改变危险因素的年轻患者的临床结果和冠状动脉病变特征。

背景：在ST段抬高型心肌梗死（STEMI）患者中，无标准可改变危险因素（SMuRFs：高血压、糖尿病、高胆固醇血症和吸烟）者的30天死亡率高于有SMuRFs者。冠状动脉病变特征的差异仍不清楚：对亚太心血管治疗评估网络（澳大利亚、香港、马来西亚、新加坡和越南）中年龄≤60岁的STEMI患者的数据进行了回顾性分析。排除标准包括 SMuRF 数据不完整、曾发生过心肌梗死或曾进行过冠状动脉血运重建。病变类型根据美国心脏病学会标准定义。主要不良心血管事件（MACE）定义为术前心肌梗死、急诊冠状动脉搭桥手术、脑血管事件或死亡。采用多重逻辑回归：在4404例患者中，767例（17.4%）无SMuRF。无 SMuRF 患者更年轻（中位年龄 51 岁对 53 岁；P 结论：在年轻的 STEMI 患者中，无 SMuRF 患者更年轻（中位年龄 51 岁对 53 岁；P 结论）：在年轻的 STEMI 患者中，无 SMuRF 患者的病变较短且不太复杂，但手术和短期 MACE 结果较差。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.