Absence of standard modifiable cardiovascular risk factors in NSTEMI patients was associated with lower odds of in-hospital all-cause mortality (OR 0.85; 95% CI 0.77-0.93).
Cohort (n=176,083)
Yes
Does the absence of standard modifiable cardiovascular risk factors (SMuRFs) affect in-hospital mortality and MACE in patients presenting with NSTEMI?
NSTEMI patients without standard modifiable risk factors receive less guideline-directed medical therapy but have lower in-hospital mortality and MACE compared to those with risk factors.
Odds Ratio: 0.85 (95% CI 0.77–0.93)
AIMS: The importance of standard modifiable cardiovascular risk factors (SMuRFs) in preventing non-ST-segment elevation myocardial infarction (NSTEMI) is established. However, NSTEMI may present in the absence of SMuRFs, and little is known about their outcomes. METHODS AND RESULTS: We analysed 176 083 adult (≥18 years) hospitalizations with NSTEMI using data from the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP). Clinical characteristics and all-cause in-hospital mortality were analysed according to SMuRF status, with 135 223 patients presenting with at least one of diabetes, hypertension, hypercholesterolaemia, or current smoking status and 40 860 patients without any SMuRFs. Those with a history of coronary artery disease were excluded. Patients without SMuRFs were more frequently older (median age 72 year vs. 71 years, P < 0.001), male (62% vs. 61%, P < 0.001), and Caucasian (95% vs. 92%, P < 0.001). Those without SMuRFs less frequently received statins (71% vs. 81%, P < 0.001), had their left ventricular (LV) function recorded (62% vs. 65%, P < 0.001) or for those with moderate or severe LV systolic dysfunction were prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (80% vs. 85%, P < 0.001). Following propensity score matching the odds of all-cause mortality odds ratio (OR): 0.85, 95% confidence interval (CI): 0.77-0.93, cardiac mortality (OR: 0.85, 95% CI: 0.76-0.94), and major adverse cardiovascular events (MACE) (OR: 0.85, 95% CI: 0.77-0.93) were lower in patients without SMuRFs. CONCLUSION: More than one in five patients presenting with NSTEMI had no SMuRFs, who were less frequently received guideline-recommended management and had lower in-hospital (all-cause and cardiac) mortality and MACE than patients with SMuRFs.
Moledina et al. (Tue,) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=176,083). Absence of standard modifiable cardiovascular risk factors (SMuRFs) vs. Presence of at least one SMuRF (diabetes, hypertension, hypercholesterolaemia, or current smoking) was evaluated on All-cause in-hospital mortality (OR 0.85, 95% CI 0.77-0.93). Absence of standard modifiable cardiovascular risk factors in NSTEMI patients was associated with lower odds of in-hospital all-cause mortality (OR 0.85; 95% CI 0.77-0.93).