Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 24:14:100474.
doi: 10.1016/j.ajpc.2023.100474. eCollection 2023 Jun.

Mortality of patients with ST-segment-elevation myocardial infarction without standard modifiable risk factors among patients without known coronary artery disease: Age-stratified and sex-related analysis from nationwide readmissions database 2010-2014

Sun-Joo Jang  1   2 , Luke K Kim  2 , Navjot Kaur Sobti  2 , Ilhwan Yeo  2 , Jim W Cheung  2 , Dmitriy N Feldman  2 , Nivee P Amin  2   3 , David L Narotsky  4 , Parag Goyal  2   5 , S Andrew McCullough  2 , Udhay Krishnan  2 , Stuart Zarich  4 , S Chiu Wong  2 , Samuel M Kim  2
Affiliations

Mortality of patients with ST-segment-elevation myocardial infarction without standard modifiable risk factors among patients without known coronary artery disease: Age-stratified and sex-related analysis from nationwide readmissions database 2010-2014

Sun-Joo Jang et al. Am J Prev Cardiol. .

Abstract

Objective: The proportion of ST-segment elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMuRFs: hypertension, diabetes, hypercholesterolemia and smoking) has increased over time. The absence of SMuRFs is known to be associated with worse outcomes, but its association with age and sex is uncertain. We sought to evaluate the association between age and sex with the outcomes of post-STEMI patients without SMuRFs among patients without preexisting coronary artery disease.

Methods: Patients who underwent primary PCI for STEMI were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, in-hospital, and 30-day outcomes in patients with or without SMuRFs were compared in men versus women and stratified into five age groups.

Results: Between January 2010 and November 2014, of 474,234 patients who underwent primary PCI for STEMI, 52,242 (11.0%) patients did not have SMuRFs. Patients without SMuRFs had higher in-hospital mortality rates than those with SMuRFs. Among those without SMuRFs, the in-hospital mortality rate was significantly higher in women than men (10.6% vs 7.3%, p<0.001), particularly in older age groups. The absence of SMuRFs was associated with higher 30-day readmission-related mortality rates (0.5% vs 0.3% with SMuRFs, p<0.001). Among patients without SMuRFs, women had a higher 30-day readmission-related mortality rates than men (0.6% vs 0.4%, p<0.001). After multivariable adjustment, the increased rates of in-hospital (odds ratio 1.89 (95% CI 1.72 to 2.07) and 30-day readmission-related mortality (hazard ratio 1.30 (95% CI 1.01 to 1.67)) in patients without SMuRFs remained significant.

Conclusions: STEMI patients without SMuRFs have a significantly higher risk of in-hospital and 30-day mortality than those with SMuRFs. Women and older patients without SMuRFs experienced significantly higher in-hospital and 30-day readmission-related mortality.

Keywords: Cardiovascular risk factors; Mortality; PCI; STEMI.

PubMed Disclaimer

Conflict of interest statement

None declared

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
Flow diagram of patient population Abbreviations: STEMI, ST-segment elevation myocardial infarction; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; LOS, length of stay; CAD, coronary artery disease; SMuRFs, standard modifiable risk factors.
Fig 2
Fig. 2
The proportion of patients who underwent primary PCI for STEMI with vs without SMuRFs, stratified by sex and age. The proportion of patients without SMuRFs is shown in overall patients (A), men (B) and women (C)
Fig 3
Fig. 3
In-hospital mortality of patients who underwent primary PCI for STEMI with vs without SMuRFs, stratified by sex and age group. In-hospital mortality rates and adjusted odds ratio in overall patients (A, B), men (C,D) and women (E,F) are shown together.
Fig 4
Fig. 4
Thirty-day readmission mortality of patients who underwent primary PCI for STEMI with vs without SMuRFs, stratified by sex and age group. Thirty-day mortality rates and adjusted hazards ratio in overall patients (A, B), men (C,D) and women (E,F) are shown together.
See this image and copyright information in PMC

References

    1. Dawber TR, Moore FE, Mann GV. Coronary heart disease in the Framingham study. Am J Public Health Nations Health. 1957;47:4–24. doi: 10.2105/ajph.47.4_pt_2.4. - DOI - PMC - PubMed
    1. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847. doi: 10.1161/01.cir.97.18.1837. - DOI - PubMed
    1. Vernon ST, Coffey S, Bhindi R, et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur J Prev Cardiol. 2017;24:1824–1830. doi: 10.1177/2047487317720287. - DOI - PubMed
    1. Vernon ST, Coffey S, D'Souza M, et al. ST-segment-elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors-how common are they, and what are their outcomes? J Am Heart Assoc. 2019;8 doi: 10.1161/JAHA.119.013296. - DOI - PMC - PubMed
    1. Wang JY, Goodman SG, Saltzman I, et al. Cardiovascular risk factors and in-hospital mortality in acute coronary syndromes: insights from the canadian global registry of acute coronary events. Can J Cardiol. 2015;31:1455–1461. doi: 10.1016/j.cjca.2015.04.007. - DOI - PubMed

LinkOut - more resources