ST‐Segment–Elevation Myocardial Infarction (STEMI) Patients Without Standard Modifiable Cardiovascular Risk Factors—How Common Are They, and What Are Their Outcomes?

Abstract

BackgroundPrograms targeting the standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to tackling coronary heart disease at a community level. However, myocardial infarction in SMuRF‐less individuals is not uncommon. This study uses 2 sequential large, multicenter registries to examine the proportion and outcomes of SMuRF‐less ST‐segment–elevation myocardial infarction (STEMI) patients.Methods and ResultsWe identified 3081 STEMI patients without a prior history of cardiovascular disease in the Australian GRACE (Global Registry of Acute Coronary Events) and CONCORDANCE (Cooperative National Registry of Acute Coronary Syndrome Care) registries, encompassing 42 hospitals, between 1999 and 2017. We examined the proportion that were SMuRF‐less as well as outcomes. The primary outcome was in‐hospital mortality, and the secondary outcome was major adverse cardiovascular events (death, myocardial infarction, or heart failure, during the index admission). Multivariate regression models were used to identify predictors of major adverse cardiovascular events. Of STEMI patients without a prior history of cardiovascular disease 19% also had no history of SMuRFs. This proportion increased from 14% to 23% during the study period (P=0.0067). SMuRF‐less individuals had a higher in‐hospital mortality rate than individuals with 1 or more SMuRFs. There were no clinically significant differences in major adverse cardiovascular events at 6 months between the 2 groups.ConclusionsA substantial and increasing proportion of STEMI presentations occur independently of SMuRFs. Discovery of new markers and mechanisms of disease beyond standard risk factors may facilitate novel preventative strategies. Studies to assess longer‐term outcomes of SMuRF‐less STEMI patients are warranted.

Description of ST Segments Elevation of Myocardial Infarction on Patients Undergoing Primary Percutaneous Coronary Intervention in dr. M. Djamil Hospital Padang

“…In this study, all patients > 40 years old were found. This is in accordance with the research of previously report from GRACE and CONCORDANCE data in australia which found the median age of patients experiencing STEMI which is 61 years (52 years-69 years) (Vernon et al, 2019). This is consistent with a population study conducted by Jousilahti et al, (1999) who found that the incidence rate of coronary heart disease was three times greater in men than women and mortality rate was five times greater in men than women.…”

Circulating miR-320a as a Predictive Biomarker for Left Ventricular Remodelling in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

“…ST-segment-elevation myocardial infarction (STEMI) is considered the most common and severe acute myocardial infarction (AMI) [1]. According to current guidelines, early reperfusion of coronary flow by primary percutaneous coronary intervention (PPCI) significantly mitigates cardiac cell death and cardiovascular events.…”

A Nomogram Based on Apelin-12 for the Prediction of Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention among Patients with ST-Segment Elevation Myocardial Infarction

“…Several tools for cardiovascular disease risk and prognosis evaluation in different populations have been established to guide clinical practice. e widely used tools included the Framingham general CVD equations in the United States, the QRISK in the United Kingdom, the Systematic Coronary Risk Evaluation model in Europe, and the Pooled Cohort Equations for atherosclerotic CVD (ASCVD) released in the American Heart Association guideline, as well as rombolysis in Myocardial Infarction (TIMI) risk score, TIMI risk index, Evaluation of Methods and Management of Acute Coronary Events (EMMACE), Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), and Canada Acute Coronary Syndrome (C-ACS) Risk Score [7][8][9][10][11][12][13][14][15][16]. However, these equations presented above were all derived from Western populations, which limited their application to other populations.…”