Agarwal Manyoo A, Garg Lohit, Lavie Carl J, Reed Guy L, Khouzam Rami N
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, Lehigh Valley Medical Center, Allentown, PA, USA.
Ann Transl Med. 2018 Jan;6(1):3. doi: 10.21037/atm.2017.09.27.
Patients with a family history of coronary artery disease (FHxCAD) are at increased risk for development of myocardial infarction (MI). However, the data on the influence of FHxCAD on in-hospital clinical outcomes post ST-segment myocardial infarction (STEMI) is limited. Hence, we evaluated the impact of FHxCAD on in-hospital clinical outcomes post STEMI in an unselected nationwide cohort.
Nationwide Inpatient Sample (NIS) database [2003-2011] was used to compare differences in all-cause in-hospital mortality and adverse clinical events (cardiogenic shock, acute cerebrovascular events and use of intra-aortic balloon pump) between patients with and without FHxCAD.
A total of 2,123,492 STEMI admissions were identified, of which 7.4% (n=158,079) patients were with FHxCAD and 92.6% (n=1,965,413) were without FHxCAD. The FHxCAD group had lower in-hospital mortality [1.4% 8.1%; adjusted odds ratio (OR): 0.42, 95% confidence interval (CI): 0.41-0.44; P<0.001] when compared with no-FHxCAD group. They underwent a significantly higher number of coronary interventions, and were less likely to develop cardiogenic shock, acute cerebrovascular events and to require intra-aortic balloon pump during hospitalization.
This large sample size study demonstrates that STEMI patients with FHxCAD had lower in-hospital mortality and adverse clinical events in comparison to patients with no-FHxCAD. Further research is warranted to determine whether the superior outcomes in FHxCAD patients with STEMI are related to differences in strategies related to diet, exercise, use of medications or coronary interventions.
有冠状动脉疾病家族史（FHxCAD）的患者发生心肌梗死（MI）的风险增加。然而，关于FHxCAD对ST段抬高型心肌梗死（STEMI）后院内临床结局影响的数据有限。因此，我们在一个未经过筛选的全国性队列中评估了FHxCAD对STEMI后院内临床结局的影响。
使用全国住院患者样本（NIS）数据库[2003 - 2011年]来比较有和没有FHxCAD的患者在全因院内死亡率和不良临床事件（心源性休克、急性脑血管事件和主动脉内球囊泵的使用）方面的差异。
共确定了2123492例STEMI住院病例，其中7.4%（n = 158079）的患者有FHxCAD，92.6%（n = 1965413）的患者没有FHxCAD。与无FHxCAD组相比，FHxCAD组的院内死亡率较低[1.4%对8.1%；调整后的优势比（OR）：0.42，95%置信区间（CI）：0.41 - 0.44；P < 0.001]。他们接受冠状动脉介入治疗的次数显著更多，并且在住院期间发生心源性休克、急性脑血管事件以及需要使用主动脉内球囊泵的可能性较小。
这项大样本量研究表明，与无FHxCAD的患者相比，有FHxCAD的STEMI患者院内死亡率和不良临床事件较低。有必要进一步研究以确定有FHxCAD的STEMI患者的较好结局是否与饮食、运动、药物使用或冠状动脉介入治疗相关策略的差异有关。
