Please use this identifier to cite or link to this item: https://doi.org/10.3389/fcvm.2022.869168
Title: Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients
Authors: Kong, Gwyneth
Chew, Nicholas WS
Ng, Cheng Han
Chin, Yip Han
Lim, Oliver ZH
Ambhore, Anand 
Ng, Gavin
Kong, William
Poh, Kian-Keong 
Foo, Roger
Yip, James
Yeo, Tiong-Cheng 
Low, Adrian Fatt-Hoe 
Lee, Chi-Hang 
Chan, Mark Yan-Yee 
Tan, Huay-Cheem 
Loh, Poay-Huan 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
hypertension
hyperlipidemia
diabetes
standard modifiable cardiovascular risk factors
prognostic outcomes
smoking
acute myocardial infarction
CORONARY-HEART-DISEASE
LONG-TERM PROGNOSIS
CARDIOVASCULAR RISK
BLOOD-PRESSURE
FOLLOW-UP
PRIMARY PREVENTION
MORTALITY
INDIVIDUALS
PREVALENCE
STRATEGIES
Issue Date: 29-Mar-2022
Publisher: FRONTIERS MEDIA SA
Citation: Kong, Gwyneth, Chew, Nicholas WS, Ng, Cheng Han, Chin, Yip Han, Lim, Oliver ZH, Ambhore, Anand, Ng, Gavin, Kong, William, Poh, Kian-Keong, Foo, Roger, Yip, James, Yeo, Tiong-Cheng, Low, Adrian Fatt-Hoe, Lee, Chi-Hang, Chan, Mark Yan-Yee, Tan, Huay-Cheem, Loh, Poay-Huan (2022-03-29). Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients. FRONTIERS IN CARDIOVASCULAR MEDICINE 9. ScholarBank@NUS Repository. https://doi.org/10.3389/fcvm.2022.869168
Abstract: Background: An increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population. Methods: We recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan-Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality. Results: Standard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI: 1.09-1.86, p = 0.048), cardiogenic shock (RR: 1.31, 95% CI: 1.09-1.52, p = 0.015), and stroke (RR: 2.51, 95% CI: 1.67-3.34, p = 0.030) among SMuRF-less patients. A 30-day cardiovascular mortality was raised in the SMuRF-less group, with similar trends in men, patients with ST-segment elevation myocardial infarction (STEMI), and the three Asian ethnicities. All-cause mortality remains increased in the SMuRF-less group for up to 5 years. Conclusion: There is a significant proportion of patients with AMI without standard risk factors in Asia, who have worse short-term mortality. This calls for greater focus on the management of this unexpectedly high-risk subgroup of patients.
Source Title: FRONTIERS IN CARDIOVASCULAR MEDICINE
URI: https://scholarbank.nus.edu.sg/handle/10635/228403
ISSN: 2297055X
DOI: 10.3389/fcvm.2022.869168
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