Sokhal Balamrit Singh, Matetić Andrija, Paul Timir K, Velagapudi Poonam, Lambrinou Ekaterini, Figtree Gemma A, Rashid Muhammad, Moledina Saadiq, Vassiliou Vassilios S, Mallen Christian, Mamas Mamas A
School of Medicine, Keele University, Keele, Staffordshire, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
Int J Cardiol. 2023 Jan 15;371:391-396. doi: 10.1016/j.ijcard.2022.09.037. Epub 2022 Sep 18.
Whilst it is known patients without standard modifiable cardiovascular risk factors (SMuRF; hypertension, diabetes, hypercholesterolaemia, smoking) have worse outcomes in Type 1 acute myocardial infarction (AMI), the relationship between type 2 AMI (T2AMI) and outcomes in patients with and without SMuRF is unknown. This study aimed to determine the prevalence, characteristics and clinical outcomes of patients hospitalised with T2AMI based on the presence of SMuRF.
Using the National Inpatient Sample, all hospitalizations with a primary discharge diagnosis of T2AMI were stratified according to SMuRF status (SMuRF and SMURF-less). Primary outcome was all-cause mortality while secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding and ischemic stroke. Multivariable logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).
Among 17,595 included hospitalizations, 1345 (7.6%) were SMuRF-less and 16,250 (92.4%) were SMuRF. On adjusted analysis, SMuRF-less patients had increased odds of all-cause mortality (aOR 2.43, 95% CI 1.83 to 3.23), MACCE (aOR 2.32, 95% CI 1.79 to 2.90) and ischaemic stroke (aOR 2.57, 95% CI 1.56 to 4.24) compared to their SMuRF counterparts. Secondary diagnoses among both cohorts were similar, with respiratory disorders most prevalent followed by cardiovascular and renal disorders.
T2AMI in the absence of SMuRF was associated with worse in-hospital outcomes compared to SMuRF-less patients. There was no SMuRF-based difference in the secondary diagnoses with the most common being respiratory, cardiovascular, and renal disorders. Further studies are warranted to improve overall care and outcomes of SMuRF-less patients.
虽然已知没有标准可改变心血管危险因素（SMuRF，即高血压、糖尿病、高胆固醇血症、吸烟）的患者在1型急性心肌梗死（AMI）中预后较差，但2型AMI（T2AMI）与有无SMuRF患者的预后之间的关系尚不清楚。本研究旨在根据SMuRF的存在情况，确定因T2AMI住院患者的患病率、特征和临床结局。
利用国家住院患者样本，将所有以T2AMI为主要出院诊断的住院病例根据SMuRF状态（有SMuRF和无SMuRF）进行分层。主要结局是全因死亡率，次要结局是主要不良心血管和脑血管事件（MACCE）、大出血和缺血性中风。采用多变量逻辑回归确定调整后的优势比（aOR）及95%置信区间（95%CI）。
在纳入的17595例住院病例中，1345例（7.6%）无SMuRF，16250例（92.4%）有SMuRF。经调整分析，与有SMuRF的患者相比，无SMuRF的患者全因死亡率（aOR 2.43，95%CI 1.83至3.23）、MACCE（aOR 2.32，95%CI 1.79至2.90）和缺血性中风（aOR 2.57，95%CI 1.56至4.24）的优势比增加。两个队列的次要诊断相似，呼吸系统疾病最常见其次是心血管和肾脏疾病。
与无SMuRF的患者相比，无标准可改变心血管危险因素的T2AMI患者住院结局更差。次要诊断方面不存在基于SMuRF的差异，最常见的是呼吸系统、心血管和肾脏疾病。有必要进行进一步研究以改善无SMuRF患者的整体护理和结局。
