Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Keele Road, Newcastle ST5 5BG, UK.
Division of Cardiology, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
Eur J Prev Cardiol. 2022 May 25;29(7):1084-1092. doi: 10.1093/eurjpc/zwab200.
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.
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.
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.
已经确定了标准可改变心血管风险因素（SMuRFs）在预防非 ST 段抬高型心肌梗死（NSTEMI）中的重要性。然而，即使没有 SMuRFs，NSTEMI 也可能出现，并且人们对其结果知之甚少。
我们使用来自英国（UK）心肌梗死国家审计项目（MINAP）的数据，对 176083 例成年（≥18 岁）NSTEMI 住院患者进行了分析。根据 SMuRF 状况分析了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，40860 例患者没有任何 SMuRFs。排除有冠心病病史的患者。无 SMuRFs 的患者年龄较大（中位数年龄 72 岁 vs. 71 岁，P < 0.001），男性（62% vs. 61%，P < 0.001），白种人（95% vs. 92%，P < 0.001）。无 SMuRFs 的患者较少接受他汀类药物治疗（71% vs. 81%，P < 0.001），左心室（LV）功能记录（62% vs. 65%，P < 0.001）或对于中度或重度 LV 收缩功能障碍的患者，开处方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）。经过倾向评分匹配，无 SMuRFs 患者全因死亡率[比值比（OR）：0.85，95%置信区间（CI）：0.77-0.93]、心脏死亡率（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）的发生几率较低。
超过五分之一的 NSTEMI 患者没有 SMuRFs，他们接受指南推荐的治疗方案的频率较低，与有 SMuRFs 的患者相比，住院期间（全因和心脏）死亡率和 MACE 较低。
