Department of Medicine, Tower Health System, West Reading, PA.
Division of Cardiology, Reading Hospital-Tower Health, Reading, PA.
Curr Probl Cardiol. 2022 Sep;47(9):101271. doi: 10.1016/j.cpcardiol.2022.101271. Epub 2022 May 26.
Mixed results were seen in hospital outcomes comparing the first episode of ST-elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs) than with risk factors. To understand whether the first episode of STEMI SMuRFs has worse in-hospital outcomes than patients with risk factors and to identify confounders that contribute towards worse results. We queried the Nationwide Inpatient Sample for hospitalizations with a primary diagnosis of STEMI but no prior coronary disease from 2016 to 2019. Our study population was divided into 2 comparative cohorts, SMuRFs and SMuRFless STEMI, based on cardiovascular risks. We assessed demographics, in-hospital mortality, complications of the 2 groups. SMuRFless patients were statistically more likely than those with SMuRFs to be younger, white, male, and underweight (BMI < 20) and were significantly less likely to receive percutaneous coronary intervention (85.8 vs 90.7%, P < 0.001) or cardiac bypass (3.8 vs 5.9%, P < 0.001). SMURFless patients were more likely to have in-hospital mortality (15.7 vs 7.1%, unadjusted odds ratio: 2.41, 95% confidence interval: 2.27-2.56, P < 0.001), a finding that persisted when adjusted for all factors found significant in univariate analysis (adjusted odds ratio: 2.48; 95% confidence interval: 2.30-2.67, P < 0.001). Incidence of cardiac complications, including cardiogenic shock, ventricular arrhythmia, cardiac arrest, were significantly higher in the SMuRFless patients, even after statistical adjustment and sensitivity analysis. SMuRFless patients represent a sizable minority of patients presenting with STEMI and have higher mortality, complications and receive fewer invasive procedures. Patient-level studies may be necessary to understand better how to treat this subset of myocardial infarction patients. SMuRFless STEMI were statistically more likely than those with SMuRFs to be younger, white, male, and underweight (BMI < 20) and were significantly less likely to receive percutaneous coronary intervention. SMURFless patients were more likely to have in-hospital mortality, a finding that persisted when adjusted for all factors found significant in univariate analysis. Incidence of cardiac complications, including cardiogenic shock, ventricular arrhythmia, cardiac arrest, were significantly higher in the SMuRFless patients, even after statistical adjustment and sensitivity analysis. SMuRFless patients represent a sizable minority of patients presenting with STEMI and have higher mortality, complications and receive fewer invasive procedures.
比较无标准可改变心血管风险因素（SMuRFs）的首次 ST 段抬高型心肌梗死（STEMI）与有风险因素的患者，发现住院结局存在混合结果。为了了解首次 STEMI SMuRFs 是否比有风险因素的患者住院结局更差，并确定导致更差结果的混杂因素。我们从 2016 年至 2019 年，从全国住院患者样本中查询了初次诊断为 STEMI 但无既往冠心病的住院患者。我们的研究人群根据心血管风险分为 2 个比较队列，即 SMuRFs 和 SMuRFless STEMI。我们评估了两组患者的人口统计学特征、住院死亡率和并发症。SMuRFless 患者比 SMuRFs 患者更年轻、白人、男性和体重不足（BMI<20），且接受经皮冠状动脉介入治疗（85.8% vs 90.7%，P<0.001）或心脏搭桥术（3.8% vs 5.9%，P<0.001）的可能性显著较低。SMURFless 患者的住院死亡率更高（15.7% vs 7.1%，未调整优势比：2.41，95%置信区间：2.27-2.56，P<0.001），当调整单因素分析中发现的所有有统计学意义的因素时，这一发现仍然存在（调整后的优势比：2.48；95%置信区间：2.30-2.67，P<0.001）。即使在进行统计调整和敏感性分析后，SMuRFless 患者的心脏并发症发生率仍然较高，包括心源性休克、室性心律失常、心脏骤停。SMuRFless 患者是 STEMI 患者中相当大的少数人群，死亡率、并发症更高，接受的侵入性治疗更少。可能需要进行患者水平的研究，以更好地了解如何治疗这部分心肌梗死患者。与有 SMuRFs 的患者相比，SMuRFless 患者更年轻、白人、男性和体重不足（BMI<20），且接受经皮冠状动脉介入治疗的可能性显著较低。SMURFless 患者的住院死亡率更高，这一发现在调整单因素分析中发现的所有有统计学意义的因素后仍然存在。即使在进行统计调整和敏感性分析后，SMuRFless 患者的心脏并发症发生率仍然较高，包括心源性休克、室性心律失常、心脏骤停。SMuRFless 患者是 STEMI 患者中相当大的少数人群，死亡率、并发症更高，接受的侵入性治疗更少。
