2010 - 2014年全国再入院数据库中无已知冠状动脉疾病患者中无标准可改变风险因素的ST段抬高型心肌梗死患者的死亡率：年龄分层及性别相关分析
Mortality of patients with ST-segment-elevation myocardial infarction without standard modifiable risk factors among patients without known coronary artery disease: Age-stratified and sex-related analysis from nationwide readmissions database 2010-2014.
作者信息
Jang Sun-Joo, Kim Luke K, Sobti Navjot Kaur, Yeo Ilhwan, Cheung Jim W, Feldman Dmitriy N, Amin Nivee P, Narotsky David L, Goyal Parag, McCullough S Andrew, Krishnan Udhay, Zarich Stuart, Wong S Chiu, Kim Samuel M
机构信息
Department of Medicine, Yale New Haven Health/Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, United States.
Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States.
出版信息
Am J Prev Cardiol. 2023 Feb 24;14:100474. doi: 10.1016/j.ajpc.2023.100474. eCollection 2023 Jun.
OBJECTIVE
The proportion of ST-segment elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMuRFs: hypertension, diabetes, hypercholesterolemia and smoking) has increased over time. The absence of SMuRFs is known to be associated with worse outcomes, but its association with age and sex is uncertain. We sought to evaluate the association between age and sex with the outcomes of post-STEMI patients without SMuRFs among patients without preexisting coronary artery disease.
METHODS
Patients who underwent primary PCI for STEMI were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, in-hospital, and 30-day outcomes in patients with or without SMuRFs were compared in men versus women and stratified into five age groups.
RESULTS
Between January 2010 and November 2014, of 474,234 patients who underwent primary PCI for STEMI, 52,242 (11.0%) patients did not have SMuRFs. Patients without SMuRFs had higher in-hospital mortality rates than those with SMuRFs. Among those without SMuRFs, the in-hospital mortality rate was significantly higher in women than men (10.6% vs 7.3%, p<0.001), particularly in older age groups. The absence of SMuRFs was associated with higher 30-day readmission-related mortality rates (0.5% vs 0.3% with SMuRFs, p<0.001). Among patients without SMuRFs, women had a higher 30-day readmission-related mortality rates than men (0.6% vs 0.4%, p<0.001). After multivariable adjustment, the increased rates of in-hospital (odds ratio 1.89 (95% CI 1.72 to 2.07) and 30-day readmission-related mortality (hazard ratio 1.30 (95% CI 1.01 to 1.67)) in patients without SMuRFs remained significant.
CONCLUSIONS
STEMI patients without SMuRFs have a significantly higher risk of in-hospital and 30-day mortality than those with SMuRFs. Women and older patients without SMuRFs experienced significantly higher in-hospital and 30-day readmission-related mortality.
目的
无标准可改变风险因素（SMuRFs：高血压、糖尿病、高胆固醇血症和吸烟）的ST段抬高型心肌梗死（STEMI）患者比例随时间增加。已知无SMuRFs与更差的预后相关，但其与年龄和性别的关联尚不确定。我们试图评估在无既往冠状动脉疾病的患者中，年龄和性别与无SMuRFs的STEMI后患者预后之间的关联。
方法
从美国全国再入院数据库中识别出接受STEMI直接经皮冠状动脉介入治疗（PCI）的患者。比较有无SMuRFs患者的临床特征、住院期间及30天预后，按男性和女性分层，并分为五个年龄组。
结果
在2010年1月至2014年11月期间，474234例接受STEMI直接PCI的患者中，52242例（11.0%）患者无SMuRFs。无SMuRFs的患者住院死亡率高于有SMuRFs的患者。在无SMuRFs的患者中，女性的住院死亡率显著高于男性（10.6%对7.3%，p<0.001），尤其是在老年组。无SMuRFs与30天再入院相关死亡率较高相关（0.5%对有SMuRFs的0.3%，p<0.001）。在无SMuRFs的患者中，女性的30天再入院相关死亡率高于男性（0.6%对0.4%，p<0.001）。多变量调整后，无SMuRFs患者的住院死亡率增加率（比值比1.89（95%CI 1.72至2.07））和30天再入院相关死亡率（风险比1.30（95%CI 1.0～1.67））仍具有显著性。
结论
无SMuRFs的STEMI患者的住院及30天死亡率风险显著高于有SMuRFs的患者。无SMuRFs的女性和老年患者的住院及30天再入院相关死亡率显著更高。
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