无标准可调节心血管危险因素的 ST 段抬高型心肌梗死的结局-来自印度前瞻性登记研究的新见解。
Outcomes of ST Segment Elevation Myocardial Infarction without Standard Modifiable Cardiovascular Risk Factors - Newer Insights from a Prospective Registry in India.
机构信息
Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India.
Rajiv Gandhi Government General Hospital, Park Town, Chennai, India.
出版信息
Glob Heart. 2023 Mar 16;18(1):13. doi: 10.5334/gh.1189. eCollection 2023.
OBJECTIVES
Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs.
METHODS
We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5 extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality.
RESULTS
Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year all-cause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5 eSMuRF yielded similar results.
CONCLUSIONS
25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.
目的
有研究报道，与存在标准可调节心血管风险因素（SMuRFs；血脂异常、高血压、糖尿病和吸烟）的 ST 段抬高型心肌梗死（STEMI）患者相比，无 SMuRFs 的 STEMI 患者的临床结局更差。然而，目前缺乏强有力的前瞻性数据和中低收入国家的相关研究。本研究旨在分析首次发生 STEMI 的患者，并通过比较有无 SMuRFs 的患者，评估 SMuRFs 对临床结局的影响。
方法
本研究纳入了 2018 年 9 月至 2019 年 10 月期间在马德拉斯医学院 STEMI 注册研究中连续登记的所有首次发生 STEMI 且无既往冠状动脉疾病的患者。我们收集了基线临床特征、血运重建策略和临床结局等数据。我们分析了自评睡眠时间不理想（5 个扩展 SMuRF，eSMuRF）作为一个 SMuRF。主要结局为住院期间死亡率。次要结局包括住院期间并发症和 1 年全因死亡率。
结果
在 2379 例患者中，605 例（25.4%）为无 SMuRFs。与男性相比，女性无 SMuRFs 的比例更高（27.1% vs 22.1%；P=0.012）。无 SMuRFs 的患者年龄更大（57.44±13.95 岁 vs 55.68±11.74 岁；P＜0.001），更常见曾吸烟（10.4% vs 5.0%；P＜0.001），前壁心肌梗死的比例更高（62.6% vs 52.1%；P=0.032）。主要结局[住院期间死亡率（10.7% vs 11.3%；P=0.72）]和次要结局[住院期间并发症（29.1% vs 31.7%；P=0.23）和 1 年全因死亡率（22.3% vs 22.7%；P=0.85）]在两组之间无显著差异。将自评睡眠时间不理想作为第 5 个 eSMuRF 纳入分析后，结果也相似。
结论
25%的首次发生 STEMI 的患者无 SMuRFs。无 SMuRFs 的患者的临床结局与有 SMuRFs 的患者相似。自评睡眠时间不理想并不能解释无 SMuRFs 状态与风险之间的关联。
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