Addressing disparities of care in non-ST-segment elevation myocardial infarction patients without standard modifiable risk factors: insights from a nationwide cohort study
Addressing disparities of care in non-ST-segment elevation myocardial infarction patients without standard modifiable risk factors: insights from a nationwide cohort study
复制标题
DOI：
10.1093/eurjpc/zwab200
复制
发表时间：
2021-12-13
影响因子：
8.3
通讯作者：
Mamas, Mamas A.
中科院分区：
文献类型：
--
作者：
Moledina, Saadiq M.;Rashid, Muhammad;Mamas, Mamas A.
目的：探讨标准可改变的心血管危险因素（SMuRFs）在预防非ST段抬高型心肌梗死（NSTEMI）中的重要性。然而，NSTEMI可能在没有SMuRF的情况下出现，并且对其结果知之甚少。方法和结果：我们分析了176083例成人（≥ 18岁）NSTEMI住院患者，数据来自英国（UK）心肌梗死国家审计项目（MINAP）。根据SMuRF状态分析临床特征和全因住院死亡率，其中135223例患者至少存在糖尿病、高血压、高胆固醇血症或当前吸烟状态中的一种，40860例患者没有任何SMuRF。排除有冠状动脉疾病史者。无SMuRF的患者更常见于老年人（中位年龄72岁vs. 71岁，P < 0.001）、男性（62% vs. 61%，P < 0.001）和白人（95% vs. 92%，P < 0.001）。没有SMuRF的患者较少接受他汀类药物治疗（71% vs. 81%，P < 0.001），记录了他们的左心室（LV）功能（62% vs. 65%，P < 0.001），或者对于中度或重度LV收缩功能障碍的患者，处方了血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（80% vs. 85%，P < 0.001）。根据与全因死亡率[比值比（OR）：0.85，95%置信区间（CI）：0.77-0.93]、心源性死亡率（OR：0.85，95% CI：0.76-0.94）和主要不良心血管事件（MACE）（OR：0.85，95% CI：0.77-0.93）比值匹配的倾向评分，无SMuRF的患者较低。结论超过五分之一的NSTEMI患者没有SMuRFs，与SMuRFs患者相比，他们接受指南推荐的管理频率较低，住院（全因和心源性）死亡率和MACE较低。
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.